Download PDF Immunologic Approaches to the Classification and Management of Lymphomas and Leukemias

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Aggressive lymphoma grows and spreads quickly, and has signs and symptoms that can be severe. The treatments for indolent and aggressive lymphoma are different. Primary mediastinal large B-cell lymphoma is a type of diffuse large B-cell lymphoma. Anything that increases your risk of getting a disease is called a risk factor. Talk with your doctor if you think you may be at risk. These and other risk factors may increase the risk of certain types of adult non-Hodgkin lymphoma:.

These signs and symptoms may be caused by adult non-Hodgkin lymphoma or by other conditions. Check with your doctor if you have any of the following:. When fever, night sweats, and weight loss occur together, this group of symptoms is called B symptoms. Other signs and symptoms of adult non-Hodgkin lymphoma may occur and depend on the following:. If cancer is found, the following tests may be done to study the cancer cells:. Other tests and procedures may be done depending on the signs and symptoms seen and where the cancer forms in the body.

The prognosis chance of recovery and treatment options depend on the following:. For non-Hodgkin lymphoma during pregnancy, the treatment options also depend on:. Some types of non-Hodgkin lymphoma spread more quickly than others do. Most non-Hodgkin lymphomas that occur during pregnancy are aggressive. Delaying treatment of aggressive lymphoma until after the baby is born may lessen the mother's chance of survival.

Immediate treatment is often recommended, even during pregnancy. The process used to find out the type of cancer and if cancer cells have spread within the lymph system or to other parts of the body is called staging.

What is the difference between leukemia and lymphoma?

The information gathered from the staging process determines the stage of the disease. It is important to know the stage of the disease in order to plan treatment. The results of the tests and procedures done to diagnose non-Hodgkin lymphoma are used to help make decisions about treatment. The following tests and procedures may also be used in the staging process:.

For pregnant women with non-Hodgkin lymphoma, staging tests and procedures that protect the baby from the harms of radiation are used. These tests and procedures include MRI, bone marrow aspiration and biopsy, lumbar puncture, and ultrasound. An ultrasound exam is a procedure in which high-energy sound waves ultrasound are bounced off internal tissues or organs and make echoes.

The echoes form a picture of body tissues called a sonogram. Cancer can spread through tissue , the lymph system , and the blood :.


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In stage I, cancer is found in one of the following places in the lymph system :. In stage II, the term bulky disease refers to a larger tumor mass. The size of the tumor mass that is referred to as bulky disease varies based on the type of lymphoma. In stage III adult non-Hodgkin lymphoma , cancer is found:. In stage IV adult non-Hodgkin lymphoma , cancer :. See the General Information section for more information on the types of indolent slow-growing and aggressive fast-growing non-Hodgkin lymphoma.

Non-Hodgkin lymphoma can also be described as contiguous or noncontiguous :. Recurrent adult non-Hodgkin lymphoma is cancer that has recurred come back after it has been treated. The lymphoma may come back in the lymph system or in other parts of the body. Indolent lymphoma may come back as aggressive lymphoma. Aggressive lymphoma may come back as indolent lymphoma. Different types of treatment are available for patients with non-Hodgkin lymphoma.

Some treatments are standard the currently used treatment , and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer.

When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment. For pregnant women with non-Hodgkin lymphoma, treatment is carefully chosen to protect the baby. The treatment plan may change as the signs and symptoms , cancer, and pregnancy change. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Treatment will be overseen by a medical oncologist , a doctor who specializes in treating cancer, or a hematologist , a doctor who specializes in treating blood cancers. The medical oncologist may refer you to other health care providers who have experience and are experts in treating adult non-Hodgkin lymphoma and who specialize in certain areas of medicine. These may include the following specialists :. For information about side effects that begin during treatment for cancer, see our Side Effects page.

Side effects from cancer treatment that begin after treatment and continue for months or years are called late effects. Treatment with chemotherapy , radiation therapy , or stem cell transplant for non-Hodgkin lymphoma may increase the risk of late effects. Some late effects may be treated or controlled. It is important to talk with your doctor about the effects cancer treatment can have on you. Regular follow-up to check for late effects is important. Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing.

There are two types of radiation therapy:. Total-body irradiation is a type of external radiation therapy that is given to the entire body. It may be given before a stem cell transplant. The way the radiation therapy is given depends on the type and stage of the cancer being treated. External radiation therapy is used to treat adult non-Hodgkin lymphoma, and may also be used as palliative therapy to relieve symptoms and improve quality of life. For pregnant women with non-Hodgkin lymphoma, radiation therapy should be given after delivery, if possible, to avoid any risk to the baby.

If treatment is needed right away, pregnant women may decide to continue the pregnancy and receive radiation therapy. However, lead used to shield the baby may not protect it from scattered radiation that could possibly cause cancer in the future. Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing.

When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body systemic chemotherapy. When chemotherapy is placed directly into the cerebrospinal fluid intrathecal chemotherapy , an organ , or a body cavity such as the abdomen , the drugs mainly affect cancer cells in those areas regional chemotherapy. Combination chemotherapy is treatment using two or more anticancer drugs. Steroid drugs may be added, to lessen inflammation and lower the body's immune response.

The way the chemotherapy is given depends on the type and stage of the cancer being treated. Intrathecal chemotherapy may also be used in the treatment of lymphoma that first forms in the testicles or sinuses hollow areas around the nose, diffuse large B-cell lymphoma , Burkitt lymphoma , lymphoblastic lymphoma , and some aggressive T-cell lymphomas. It is given to lessen the chance that lymphoma cells will spread to the brain and spinal cord. This is called CNS prophylaxis.

In pregnant women, the baby is exposed to chemotherapy when the mother is treated, and some anticancer drugs cause birth defects. Because anticancer drugs are passed to the baby through the mother, both must be watched closely when chemotherapy is given. Immunomodulators and CAR T-cell therapy are types of immunotherapy. Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells.

Monoclonal antibody therapy , proteasome inhibitor therapy, and kinase inhibitor therapy are types of targeted therapy used to treat adult non-Hodgkin lymphoma. Monoclonal antibody therapy is a cancer treatment that uses antibodies made in the laboratory from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading.

They may be used alone or to carry drugs, toxins , or radioactive material directly to cancer cells. Rituximab is a monoclonal antibody used to treat many types of non-Hodgkin lymphoma. Obinutuzumab is a monoclonal antibody used to treat follicular lymphoma. Monoclonal antibodies that have been joined to radioactive material are called radiolabeled monoclonal antibodies. Yttrium Y ibritumomab tiuxetan is an example of a radiolabeled monoclonal antibody. Monoclonal antibodies are given by infusion. Proteasome inhibitor therapy blocks the action of proteasomes in cancer cells. Proteasomes remove proteins no longer needed by the cell.

When the proteasomes are blocked, the proteins build up in the cell and may cause the cancer cell to die. Bortezomib is used to decrease how much immunoglobulin M is in the blood after cancer treatment for lymphoplasmacytic lymphoma. It is also being studied to treat relapsed mantle cell lymphoma. Kinase inhibitor therapy blocks certain proteins, which may help keep lymphoma cells from growing and may kill them. Ibrutinib , a type of Bruton's tyrosine kinase inhibitor therapy, isused to treat lymphoplasmacytic lymphoma and mantle cell lymphoma.

If the blood becomes thick with extra antibody proteins and affects circulation , plasmapheresis is done to remove extra plasma and antibody proteins from the blood. In this procedure, blood is removed from the patient and sent through a machine that separates the plasma the liquid part of the blood from the blood cells. The patient's plasma contains the unneeded antibodies and is not returned to the patient. The normal blood cells are returned to the bloodstream along with donated plasma or a plasma replacement.

Plasmapheresis does not keep new antibodies from forming. Antibiotic therapy is a treatment that uses drugs to treat infections and cancer caused by bacteria and other microorganisms. Surgery may be used to remove the lymphoma in certain patients with indolent or aggressive non-Hodgkin lymphoma. The type of surgery used depends on where the lymphoma formed in the body:. Patients who have a heart, lung , liver , kidney , or pancreas transplant usually need to take drugs to suppress their immune system for the rest of their lives.

Long-term immunosuppression after an organ transplant can cause a certain type of non-Hodgkin lymphoma called post-transplant lymphoproliferative disorder PLTD. Small bowel surgery is often needed to diagnose celiac disease in adults who develop a type of T-cell lymphoma.

Stem cells immature blood cells are removed from the blood or bone marrow of the patient autologous transplant or a donor allogeneic transplant and are frozen and stored. This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website. Vaccine therapy is a cancer treatment that uses a substance or group of substances to stimulate the immune system to find the tumor and kill it. For some patients, taking part in a clinical trial may be the best treatment choice.

Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment. Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment. Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring coming back or reduce the side effects of cancer treatment. Clinical trials are taking place in many parts of the country. Clinical trials supported by other organizations can be found on the ClinicalTrials.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred come back.

These tests are sometimes called follow-up tests or check-ups.

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For information about the treatments listed below, see the Treatment Option Overview section. Treatment of indolent stage I and indolent, contiguous stage II adult non-Hodgkin lymphoma may include the following:. If the tumor is too large to be treated with radiation therapy, the treatment options for indolent, noncontiguous stage II , III , or IV adult non-Hodgkin lymphoma will be used.

After initial treatment with the monoclonal antibody rituximab with or without chemotherapy, more treatment with rituximab may be given. Other treatments for indolent non-Hodgkin lymphoma depend on the type of non-Hodgkin lymphoma. Treatment may include the following:. Treatment of aggressive stage I and aggressive, contiguous stage II adult non-Hodgkin lymphoma may include the following:. Other treatments depend on the type of aggressive non-Hodgkin lymphoma. For information on the treatment of lymphoblastic lymphoma, see Treatment Options for Lymphoblastic Lymphoma and for information on the treatment of Burkitt lymphoma, see Treatment Options for Burkitt Lymphoma.

Treatment of adult lymphoblastic lymphoma may include the following:. Treatment of adult Burkitt lymphoma may include the following:. Treatment of indolent , recurrent adult non-Hodgkin lymphoma may include the following:. Treatment of aggressive , recurrent adult non-Hodgkin lymphoma may include the following:. Treatment of indolent lymphoma that comes back as aggressive lymphoma depends on the type of non-Hodgkin lymphoma and may include radiation therapy as palliative therapy to relieve symptoms and improve quality of life. Treatment of aggressive lymphoma that comes back as indolent lymphoma may include chemotherapy.

Women who have indolent slow-growing non-Hodgkin lymphoma during pregnancy may be treated with watchful waiting until after they give birth. Treatment of aggressive non-Hodgkin lymphoma during pregnancy may include the following:. For more information from the National Cancer Institute about adult non-Hodgkin lymphoma, see the following:.

For general cancer information and other resources from the National Cancer Institute, see the following:. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language.

The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish. The PDQ summaries are based on an independent review of the medical literature. This PDQ cancer information summary has current information about the treatment of adult non-Hodgkin lymphoma. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care. Editorial Boards write the PDQ cancer information summaries and keep them up to date.

These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary "Updated" is the date of the most recent change. The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Adult Treatment Editorial Board.

A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works.

If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard. Clinical trials can be found online at NCI's website. PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly.

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Diffuse Large B-Cell Lymphoma Diagnosis& Treatment - Aggressive B-Cell Non-Hodgkin’s Lymphoma

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Types of B-cell Lymphoma

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Types of B-cell Lymphoma

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