A National Cancer Institute-designated Comprehensive Cancer Center

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Lymphoma

Lymphoma
Lymphoma is a group of cancers originating in the lymphatic system, which helps the body fight infection and disease.
 
For people who are diagnosed with lymphoma, City of Hope is one of the biggest and most successful treatment centers in the nation. Because of our vast experience in treating patients with lymphoma, our specialists lead the field of hematopoietic cell transplantation (HCT) with excellent outcomes.

City of Hope is designated by the National Cancer Institute as a comprehensive cancer center with a program of research and treatment excellence specializing in lymphoma. This means our patients receive superior care following the latest clinical guidelines and have the ability to enroll in our lymphoma clinical trials studying novel, promising methods to more effectively treat or prevent lymphomas.
 
 
City of Hope physicians treat many types of lymphoma and may be able to treat rarer lymphomas that have not been formally classified:
 
 
Lymphoma treatment options include transplant and non-transplant therapies. City of Hope offers the broadest and most up-to-date range of therapeutic options available, including immunotherapy, radioimmunotherapy, and adoptive T cell therapy.
 
City of Hope also pioneered innovative stem cell transplant regimens that have improved the cure rate for patients with Hodgkin lymphoma, non-Hodgkin lymphoma and other hematologic disorders.  These include: autologous stem cell transplantation, allogeneic stem cell transplantation, and nonmyeloablative (''mini") transplants. Our transplant program is accredited by the Foundation for the Accreditation of Cellular Therapy (FACT), the standard of excellence for blood and bone marrow transplant programs in the United States.
 
Delivered by a multidisciplinary treatment team that works closely and collaboratively, lymphoma treatment planning begins upon the very first visit. Because of the close coordination among our specialists, there is a smoother transition and expedited treatment for those patients who ultimately need a stem cell transplant.
 
 
Our Developmental Cancer Therapeutics Program has an active portfolio of trials for patients with recurrent lymphoma, including trials of new chemotherapy and immunotherapy drugs. We are also actively involved in survivorship research.
 
City of Hope’s Lymphoma Specialized Program of Research Excellence (SPORE) program is focused on developing translational studies to improve the detection and therapy of Hodgkin and non-Hodgkin lymphoma. Its goal is also to create lymphoma therapies that will reduce toxicities associated with current treatment regimens. Those new therapies can then be translated for use in older patient populations.
 
 
If you have been diagnosed with lymphoma or are looking for a second opinion consultation about your treatment, find out more about becoming a patient or contact us at 800-826-HOPE.
 

About Hodgkin Lymphoma

Hodgkin lymphoma, also known as Hodgkin disease, accounts for less than 12 percent of all lymphomas diagnosed annually. It is characterized by painless enlargement of one or more lymph nodes that feel swollen and rubbery. Affected lymph nodes are usually in the neck, shoulders or chest areas.

Hodgkin lymphoma is distinguished from other lymphatic cancers by the presence of a Reed-Sternberg cell, a large malignant cell in the lymph node.

Hodgkin lymphoma occurs relatively frequently among adolescents and young adults and typically has very high survival rates. Cure is often achievable when diagnosed and promptly treated in early stages.
 
Types of Hodgkin Lymphoma
 
At City of Hope, types of Hodgkin lymphoma treated include, but is not limited to, the below:
 
  • Classic Hodgkin lymphoma
    • Lymphocyte depletion Hodgkin lymphoma
    • Lymphocyte-rich Hodgkin lymphoma
    • Mixed cellularity Hodgkin lymphoma
    • Nodular sclerosing Hodgkin lymphoma
       
  • Lymphocyte-predominant Hodgkin lymphoma
 
Hodgkin Lymphoma Signs and Symptoms
 
The following represent symptoms typical for a variety of lymphomas:
 
  • Enlargement of lymph nodes, spleen, or other immune tissue
  • Unexplained Fever
  • Unexplained weight loss
  • Itching skin
  • Fatigue
  • Night sweats
 
Hodgkin Lymphoma Risk Factors
 
Risk factors for Hodgkin lymphoma include the following:

  • Certain infections: Having certain types of infections increases the risk of developing Hodgkin lymphoma. However, Hodgkin lymphoma is not contagious.
  • Epstein-Barr Virus (EBV) infection/mononucleosis: People who have had infectious mononucleosis (sometimes called mono for short), an infection caused by EBV, have an increased risk of Hodgkin lymphoma. The risk appears to be a few times higher than for people who have not had mono, although the overall risk is still very small.  Many people are infected with EBV, but very few develop Hodgkin disease.
  • HIV infection: The risk of Hodgkin lymphoma is increased in people infected with HIV, the virus that causes AIDS.
  • Family history: Siblings, particularly identical twins, of young people diagnosed with Hodgkin lymphoma will have a higher risk for disease themselves. However, a family link is still uncommon, and it is seen in only around 5% of all cases.
  • Age: Anyone can be diagnosed with Hodgkin lymphoma, but it is most common in early adulthood (ages 15 to 40, especially in a person’s 20s) and in late adulthood (after age 55).
  • Gender: Hodgkin lymphoma occurs slightly more often in males than in females.
 
Note that having one or more risk factors does not mean that a person will develop lymphoma. Most people who have risk factors never develop cancer. Likewise, some people who develop lymphoma may not have any risk factors present.

If you suspect that you or a loved one may have lymphoma, please contact your doctor for a medical examination.

Sources: American Cancer Society and National Cancer Institute

About Non-Hodgkin Lymphoma

Non-Hodgkin lymphoma is a general term representing a very diverse group of cancers, each with distinct characteristics that calls for a unique form of diagnosis and treatment.
 
Generally, non-Hodgkin lymphomas are further classified according to the type of lymphatic cells that are cancerous, such as B cells (those that produce antibodies to fight diseases), T cells (those that form non-antibody immune responses) and NK—or natural killer—cells (which normally destroy cells are infected or going through cancerous changes.)
 
The prognosis and treatment options vary depending on the subtype and stage of non-Hodgkin lymphoma upon diagnosis, but generally those that are diagnosed at earlier stages will have more favorable outcomes.
 
Types of Non-Hodgkin Lymphoma
 
At City of Hope, types of non-Hodgkin lymphoma treated include, but is not limited to, the below:
 
  • B-cell lymphoma
    • Burkitt lymphoma
    • Diffuse large B-cell lymphoma
    • Follicular lymphoma
    • Hairy cell lymphoma
    • Lymphoplasmacytic lymphoma (Waldenstrom’s macroglobulinemia)
    • Mantle cell lymphoma
    • Marginal zone B-cell lymphoma
    • Prolymphocytic B-cell lymphoma
    • Small lymphocytic lymphoma / chronic lymphocytic leukemia
       
  • Natural killer (NK) cell lymphoma
    • Aggressive NK cell lymphoma
    • Blastic NK cell lymphoma
    • Extranodal NK cell lymphoma
       
  • T-cell lymphoma
    • Peripheral T-cell lymphomas
      • Anaplastic large cell lymphoma
      • Angioimmunoblastic T-cell lymphoma
      • Cutaneous/subcutaneous T-cell lymphoma
      • Enteropathy type intestinal T-cell lymphoma
      • Extranodal T-cell lymphoma
    • Precursor T-lymphoblastic lymphoma/leukemia
 
Non-Hodgkin Lymphoma Signs and Symptoms
 
The following represent symptoms typical for a variety of lymphomas:
 
  • Enlargement of lymph nodes, spleen, or other immune tissue
  • Unexplained Fever
  • Unexplained weight loss
  • Itching skin
  • Fatigue
  • Night sweats
 
Depending on the lymph nodes or organs affected by the disease, these localized symptoms may also be present:
 
  • Red or purple bumps under the skin
  • Shortness of breath and persistent coughing 
  • Feeling pressure on the chest
  • Abdominal pain
  • Feeling full after eating a small amount of food
  • Nausea
  • Disruption in bowel movements
 
Non-Hodgkin Lymphoma Risk Factors
 
Risk factors for non-Hodgkin lymphoma include the following:

  • Weakened immune system: The risk of developing lymphoma may be increased by having a weakened immune system (such as from an inherited condition or certain drugs used after an organ transplant).
     
  • Certain infections: Having certain types of infections increases the risk of developing lymphoma. However, lymphoma is not contagious. You cannot catch lymphoma from another person. The following are the main types of infection that can increase the risk of lymphoma:
    • Human immunodeficiency virus (HIV): HIV is the virus that causes AIDS. People who have HIV infection are at much greater risk of some types of non-Hodgkin lymphoma.
    • Epstein-Barr Virus (EBV) infection/mononucleosis: Infection with EBV has been linked to an increased risk of lymphoma.
    • Helicobacter pylori: H. pylori are bacteria that can cause stomach ulcers and can also increase a person's risk of lymphoma in the stomach lining.
    • Human T-cell leukemia/lymphoma virus type 1 (HTLV-1): Infection with HTLV-1 increases a person's risk of lymphoma and leukemia.
    • Hepatitis C virus: Some studies have found an increased risk of lymphoma in people with hepatitis C virus. More research is needed to understand the role of hepatitis C virus.
       
  • Age: Although non-Hodgkin lymphoma can occur in young people, the chance of developing this disease goes up with age. Most people with non-Hodgkin lymphoma are older than 60.

Note that having one or more risk factors does not mean that a person will develop lymphoma, most people who have risk factors never develop cancer. Likewise, some people who develop lymphoma may not have any risk factors present.

If you suspect that you or a loved one may have lymphoma, please contact your doctor for a medical examination.

Sources: American Cancer Society and National Cancer Institute
 

Diagnosing and Staging Lymphoma

To accurately diagnose lymphoma, the City of Hope care team may need to perform several tests to determine the lymphoma type and stage. Staging reveals whether the cancer cells have spread within the lymphatic system or to other parts of the body, which will guide our care team’s treatment planning.
 
In addition to a routine physical exam, taking medical history information and blood tests, City of Hope staff may also perform biopsies and imaging tests.
 
Biopsies for Lymphoma
 
Due to the diverse nature of lymphomas, a biopsy—an examination of the suspected tissue—is needed to accurately identify the type of lymphoma. This tissue may be taken from a lymph node and/or the bone marrow.
 
After the tissue is extracted, a pathologist will examine the cells under a microscope to see if lymphoma present and if so, what type. Additional tests, such as immunophenotyping, cytogenetics and molecular evaluation, may also be conducted on these cells to help determine the lymphoma type.
 
Imaging Tests for Lymphoma
 
In general, imaging scans are used to determine the extent of the disease and are repeated regularly during treatment to assess cancer response. These scans may include:
 
  • Chest X-ray
  • Ultrasound: High-energy sound waves are bounced off internal tissues or organs to create an image called a sonogram.
  • CT or CAT (Computerized Axial Tomography) Scan: This procedure uses a computer connected to an X-ray machine to obtain detailed pictures of areas inside the body. A dye may be used to help visualize organs or tissues more clearly.
  • PET (Positron Emission Tomography) scan: This scan measures the metabolism of a tumor relative to normal tissue and can help determine where in the body there is active tumor.
  • MRI (Magnetic Resonance Imaging): Using a powerful magnet, radio waves and computer imaging, this procedure creates a series of detailed pictures of areas inside the body.
 
Stages of Lymphoma
Stage I: The lymphoma cells are in one lymph node group (such as in the neck or underarm). Or, if the abnormal cells are not in the lymph nodes, they are in only one part of a tissue or organ (such as the lung, but not the liver or bone marrow).

Stage II: The lymphoma cells are in at least two lymph node groups on the same side of (either above or below) the diaphragm. Or, the lymphoma cells are in one part of an organ and the lymph nodes near that organ (on the same side of the diaphragm). There may be lymphoma cells in other lymph node groups on the same side of the diaphragm.

Stage III: The lymphoma is in lymph nodes above and below the diaphragm. It also may be found in one part of a tissue or an organ near these lymph node groups.

Stage IV: Lymphoma cells are found in several parts of one or more organs or tissues (in addition to the lymph nodes). Or, it is in the liver, blood, or bone marrow.

Recurrent: The disease returns after treatment.
 
In addition to these stage numbers, the stage may be described as A or B:
 
A: You have not had weight loss, drenching night sweats, or fevers.

B: You have had weight loss, drenching night sweats, or fevers.

Our Treatment Approach

At City of Hope, patients are provided treatments based on the latest evidence available and up-to-date clinical guidelines.

Factors that determine the therapy regimen include:

  • Type of lymphoma
  • Stage of lymphoma
  • Prior therapies, if any
  • Patient’s characteristics, such as age and overall health
  • Choice of the patient and care provider, if multiple treatment options are available

Based on these factors, the lymphoma treatment regimen may include one or more of the following:

Chemotherapy

Chemotherapy, or the use of cancer-fighting drugs, is often an essential component of lymphoma treatment because a systemic approach is necessary to kill cancerous cells circulating throughout the lymphatic system. Chemotherapy is usually given in cycles, starting with treatment over several days. It is then followed by a few weeks without treatment so that the patient can recover from side effects, such as anemia and low white blood cell count. The sequence is then repeated until the disease is in remission and then the regimen may be continued to prolong survival or reduce likelihood of relapse.

Standard chemotherapy drugs used for lymphoma may include one or more of the following:
 
  • bleomycin (Blenoxane®)
  • cyclophosphamide (Cytoxan®)
  • dacarbazine (DTIC-Dome®)
  • daunorubicin doxorubicin (Adriamycin®)
  • etoposide (VP-16, VePesid®)
  • mechlorethamine (Mustargen®, a.k.a. nitrogen mustard)
  • prednisone
  • procarbazine (Matulane®)
  • vinblastine (Velban®)
  • vincristine (Oncovin®)
 
Additionally, City of Hope researchers and clinicians are constantly developing new regimens to improve the effectiveness of existing drugs or building new drugs that are more powerful against lymphoma. In particular, City of Hope’s Lymphoma Specialized Program of Research Excellence is focused on creating therapies that are less toxic to the patients. This allow patients to tolerate more potent doses of chemotherapy and open up new treatment options for groups prone to side effects, such as older patients.
 

Immunotherapy

By modifying the immune system, the patient’s own disease-fighting cells can be used to track and attack lymphoma cells throughout the body. This can dramatically enhance outcomes, whether used alone or in combination with other therapies.
 
Immunotherapy approaches being used or studied at City of Hope include:
 
Monoclonal Antibodies
 
Unlike standard chemotherapy that typically affects both cancerous and normal cells, monoclonal therapies are highly targeted drugs that can hone in on cancer cells. After attaching to the cell, the antibody can interfere with the lymphoma’s growth, be used as a delivery or targeting mechanism for other cancer therapies and/or trigger an immune response against  the lymphoma.
 
These antibodies can work alone or can be given in combination with chemotherapy. Common monoclonal antibody treatments include:
 
  • rituximab (Rituxan®)
  • tositumomab (Bexxar®)
  • ibrituomab (Zevalin®)
 
City of Hope has developed novel ways of delivering radiation utilizing monoclonal antibodies, part of the immune system, that have been combined with small amounts of radioactive substances. These radio-labeled antibodies allow doctors to target lymphoma cells directly while minimizing damage to normal tissues. City of Hope was one of the first programs to use radioimmunotherapy as part of a transplant regimen to improve the safety and efficacy of the treatment.

Adoptive T-Cell Therapy
 
T-cells are a powerful part of the immune system, and new approach being studied at City of Hope involves redirecting T-cells to recognize cancer cells specific to lymphoma. T-cells are extracted from lymphoma and then genetically modified so they recognize, target and destroy the cancer cells. Studies are ongoing for this novel approach for a number of lymphomas, particularly ones that are recurrent, relapsed or refractory.
 

Stem Cell Transplantation

City of Hope is a leader in the use of stem cell transplantation to treat lymphoma and other blood disorders. Since the program began in 1976, more than 12,000 transplants have been performed and it has been recognized for superior survival outcomes for nine consecutive years—the only transplant center in the United States with such an achievement.
 
Transplants are sometimes performed early in the course of treatment to improve long-term results or it may be utilized when other treatments are not working.
 
In this procedure, a patient undergoes intensive chemotherapy, and sometimes radiation therapy, to destroy the cancer-causing cells followed by an infusion of healthy new stem cells. The stem cell transplant may be either autologous (extracted from the patient’s own body) or allogeneic (using stem cells taken from another person.)

 
In autologous transplants, a patient donates and receives back his or her own stem cells, typically collected from peripheral (circulating) blood. City of Hope has pioneered the use of early autologous stem cell transplantation in patients with aggressive non-Hodgkin lymphoma to avoid relapse after initial treatment. This is also the most effective treatment for most patients with a lymphoma recurrence.
 
Patients with Hodgkin or AIDS-related lymphomas are sometimes good candidates for autologous stem cell transplantation. City of Hope is currently conducting studies using genetically engineered autologous stem cells to provide additional resistance against HIV infection for patients with AIDS-related lymphoma.

 
For some patients, particularly those whose disease have advanced extensively throughout the body and bone marrow, an allogeneic transplant is preferred, using stem cells from a matched donor or cord blood.

In allogeneic transplants, the donor is preferably a relative with a matching stem cell type. Alternatively, a matched unrelated donor who has a similar genetic type may be used. At City of Hope, 45 percent of allogeneic transplants come from volunteer donors who are unrelated to the patient.
 
One known complication of allogeneic transplants is graft versus host disease (GvHD), in which the newly transplanted cells does not recognize the recipient’s body as their own and forms an immune response against it. City of Hope is on the forefront of tackling this side effect and is constantly improving allogeneic transplant protocols to reduce GvHD risk and minimizing its impact if it does occur.

City of Hope physicians also specialize in “mini” stem cell transplants for patients who cannot tolerate the side effects associated with a standard stem cell transplantation, such as older patients or patients with other medical conditions. These transplants rely less on the heavy doses of chemotherapy and radiation and more on the antitumor effects of the graft itself. This novel approach has patients who otherwise ineligible, including patients in their 70s, to be treated with this lifesaving procedure.
 
 

Radiation Therapy

Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells or keep them from growing. City of Hope is the first in the western United States to treat lymphoma using the Helical TomoTherapy System®, which reduces the unwanted exposure of normal tissues and reduces potential complications. The system combines radiation delivery with real-time imaging, allowing doctors to deliver a higher dose of radiation with greater precision. This significantly improves outcomes and reduces side effects compared to traditional whole-body irradiation, which unnecessarily exposes healthy tissues.

Surgery

Because lymphoma spreads throughout the lymph system, surgery plays a limited role in treating this disease.  However, in localized tumors, such as those arising in the spleen or stomach, surgical removal may be useful. For some lymphomas of the skin, surgical excision may be part of first-line treatment.

Living With Cancer

In addition to curative treatments, City of Hope lymphoma patients and their loved ones can also access the broad range of services offered by our Department of Supportive Care Medicine. The department’s staff of professionals can help with a variety of wellness issues, including managing side effects, maintaining emotional/social/spiritual well being, staying healthy during/after treatment and building caregiving skills. Learn more about patient and caregiver support services.

More Information / Become A Patient

If you would like to learn more about our lymphoma treatment options or would like to be treated at City of Hope, please visit our Become a Patient page or call us at 626-256-HOPE (4673) to speak with one of our patient specialists.

Lymphoma Research/Clinical Trials

City of Hope has long been a leader in lymphoma research. Our research projects have been funded by the National Cancer Institute (NCI) and many other research-based organizations, and our scientists collaborate with other leading research institutions to develop tomorrow’s breakthroughs today.
 
With our extensive program of lymphoma clinical trials, City of Hope can provide our patients access to novel therapies, including many that are not available elsewhere.
 
and  Christine Brown, Ph.D., associate director of the T-cell Immunotherapy Laboratory, have opened an Food and Drug Administration (FDA )- approved clinical trial of an investigational drug for patients with T-cell lymphoma who are undergoing transplantation for recurrent disease, to reduce the chance of relapse. Plans are now underway to extend this promising new therapy to treat patients with B-cell lymphoma who are not undergoing transplantation. That trial is expected to begin this year.
 
Amrita Y. Krishnan, M.D., director, Multiple Myeloma Program, is leading an international clinical trial to test whether Zevalin radioimmunotherapy given prior to high-dose chemotherapy plus autologous stem cell transplantation will reduce the rate of disease recurrence and improve overall and disease-free survival in patients with aggressive lymphoma. City of Hope was the first institution to show that hematopoietic stem cell transplantation could cure patients of lymphoma who suffered from HIV infection. This has changed the standard of care for patients in the U.S. Joseph Alvarnas, M.D., associate clinical professor of hematology and hematopoietic cell transplantation is leading a national trial in the treatment of patients with lymphoma and HIV infection. He is also leading a study aimed at determining whether allogeneic (donor) transplants will cure both leukemia and HIV infection.
 
Leslie Popplewell, M.D., associate clinical professor , and Robert Chen, M.D., assistant professor, both of the Department of Hematology & Hematopoietic Cell Transplantation, continue to advance clinical trials of new agents that may be more effective and less toxic in treating patients with hematologic cancers. Chen led a national study of the drug brentuximab in patients with relapsed Hodgkin disease, in whom the drug produced a high rate of response. The drug was subsequently approved by the FDA. Current research is directed at assessing the efficacy of brentuximab in preparing patients for transplant, as well as in preventing posttransplant relapse.
 
 

Lymphoma Resources

 
All of our lymphoma patients have access to the services offered at Sheri & Les Biller Patient and Family Resource Center. The center’s staff is dedicated to reducing burden and promoting wellness for the patient and loved ones by providing professional services, educational programs and resource materials.
 
At the Biller Resource Center, a coordinated group of supportive care specialists will work with patients and caregivers to address their well-being concerns. This can include social workers, psychiatrists, psychologists, patient navigators, pain management specialists and spiritual care providers at the center, and programs such as music therapy, meditation and yoga.
 
The Biller Resource Center staff may be reached at 626-256-4673 ext. 32273 (3CARE).
 
Additional Resources
 
National Cancer Institute (Hodgkin Lymphoma / Non-Hodgkin Lymphoma)
American Cancer Society Lymphoma Research Foundation Cutaneous Lymphoma Foundation
 

Support This Program

It takes the help of a lot of caring people to make hope a reality for our patients. City of Hope was founded by individuals' philanthropic efforts 100 years ago. Their efforts − and those of our supporters today − have built the foundation for the care we provide and the research we conduct. It enables us to strive for new breakthroughs and better therapies − helping more people enjoy longer, better lives.


For more information on supporting this specific program, please contact us below.

Tina Pakfar, Ph.D.
Vice President
Direct: 213-241-7216
Email: tpakfar@coh.org

 
 

Lymphoma Team

A $10 million gift from Internet-publishing entrepreneurs Emmet and Toni Stephenson and their daughter Tessa Stephenson Brand will fund the creation of the Toni Stephenson Lymphoma Center at City of Hope, the cornerstone of the institution’s new Hematologic Cancers Institute.
Hematologic Cancers Support Groups
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A clinical research study is currently underway to see if low-dose tamoxifen can reduce the risk of breast cancer in childhood, adolescent, and young adulthood cancer survivors.
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