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Hodgkin's Disease Archive Questions

Below are Dr. Kimball’s answers to Hodgkin's Disease questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.

Now displaying records 1 to 15 of 26.

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Q : 1

My mom is 80 and was diagnosed with mantle cell lymphoma, stage IVB, last week. She will be on chemo every third week. Is this curable? She's been led to believe by her doctor that it is.

Mantle cell lymphoma is treatable, but not curable. There is a lot of academic discussion now about how best to treat mantle cell lymphoma, some of the new drugs are looking promising. I would be very cautious about starting an every 3 week therapy before seeking a second oncologic opinion. The every 3 week therapy that I know of can be well tolerated by 80 year olds, but can be excessively toxic, depending on the individual. I would look for an academic center near you - this is a rare disease, and she is best served by seeing a lymphoma specialist.

Q : 2

My husband had brain surgery for a large left temporal lobe lymphoma at age 32. The surgery was followed with radiation. He is now 75 and is in advanced stages of Parkinsonism. Is there any cause and effect of these two incidents in his life?

No, he is likely to have developed Parkinson's disease even without the lymphoma and its therapy.

Q : 3

My husband was recently diagnosed with Follicular Lymphoma. It is stage 3, grade 3 aggressive type. However, when I look up information, it says that follicular is indolent. I see information about grade 3a and grade 3b. Are one of these the aggressive type?

Follicular Lymphoma is considered an indolent lymphoma. When Follicular is grade 3a or 3b, many of us consider it to be aggressive, and consider treating it differently than we would for grade 1 or 2. Some references say to treat only 3b differently, others treat either 3a or 3b differently. This is an area of controversy, and it would be very reasonable to seek a second pathologic, and medical oncologic, opinion before initiating therapy.

Q : 4

I was successfully treated for NHL 18 months ago. What is the chance of recurrence? Are there lifestyle or diet changes that can reduce that chance?

The chance of recurrence depends on the kind of NHL you have. The Lymphoma Research Foundation website has information about some of the different kinds of lymphoma. Generally, you should see your oncologist every 3 months for the first 1 to 2 years after treatment, then every six months or annually. Exercising and adopting a diet rich in vegetables does seem to lower the incidence of many cancers, though ultimately the recurrence of lymphoma is beyond your control.

Q : 5

Are immunoglobulin levels important in deciding on Rituxan maintenance treatment? I have finished 6 rounds of R-CVP.

The short answer is no. Some patients who had immunoglobulin levels monitored during Rituximab maintenance therapy had levels fall, others didn't. The PRIMA study showed that Rituximab once every 2 months, for 2 years, after the initial Follicular Lymphoma therapy helped keep lymphoma away for longer.

Q : 6

I was just diagnosed with Sjorgen Syndrome and learned that I'm predisposed to get Non-Hodgkin's lymphoma. What can I do to prevent it?

A healthy lifestyle (eat well, keep fit) can only help, but ultimately, the development of lymphoma is beyond our control.

Q : 7

I am 38 years old and was diagnosed with stage 1a follicular on the left side of my groin and I am completing localized radiation. My oncologist says that there is a good chance it won't return given the localized nature of the disease. Is it worth getting a second opinion on follow ups? How often should I get scanned? What is the risk of recurrence?

Your current care is very appropriate, and I do hope that it eradicates your lymphoma. There is no consensus as to how often you should be scanned. Some would perform regularly scheduled CT's, perhaps every 3-6 months for 2 years, then annually. Other oncologists advocate for no routine surveillance scans. In either case, you should have regular oncologic follow ups, with CT scans ordered if new symptoms occur. It is important that you retain regular lymphoma follow up visits annually, for at least 20 years. One series describing patients with a situation similar to yours found that 60 percent of patients had no sign of recurrence of lymphoma over the 20 years following radiation therapy.

Q : 8

What is the survival rate for autologous stem cell transplants for NHL patients?

Of patients with Diffuse Large B-cell lymphoma who relapse after their first chemotherapy treatment (most likely with R-CHOP), 65 percent will respond to a second treatment (probably with R-ICE, or R-DHAP). This 65 percent should proceed to autologous stem cell transplant, and the majority will be alive 3 years later.

Q : 9

When non-Hodgkin's lymphoma is first found in the stomach with stomach symptoms, does this mean it has spread from the lymph nodes?

No. Lymphoma can start in the stomach. The most common example of this is MALT lymphoma, which can start in the stomach and does so most often when there is an H.Pylori infection. Diffuse large B-cell lymphoma can also start in the stomach. It is important to make sure that the biopsies of the stomach are deep enough to see how deep the lymphoma penetrates. It would also be reasonable to have an imaging study done to look for areas of enlarged lymph nodes.

Q : 10

In 2004 I had a thyroidectomy for uncontrollable Grave's Disease. They did a routine biopsy and found Marginal Zone Lymphoma. About 6 weeks ago, I noticed an enlarged lymph node under my jaw. I have lost approximately 12 pounds, feel fatigued, and sometimes have low-grade fevers. I saw my oncologist and he is ordering a CT scan but said that even if that lymph node is enlarged as well as some he found to be a bit enlarged by my collarbone, he would recommend no treatment since I have a slow growing Lymphoma. Should I get a second opinion?

Marginal Zone lymphoma is one of the tricky ones. I was just trying to help one of my patients learn about it, and discovered that even the Lymphoma Research Foundation (who are excellent) have not created a patient information page on MZL. Marginal zone is in the family of 'indolent' lymphomas. MZL is rare and slow-growing. When it involves a single area of the body, radiation therapy is a good treatment option that may provide a cure. When MZL is too big to irradiate, medical oncologists don't agree about what is best to do. Treatments may provide relief of symptoms but are not known to prolong life. "Watchful waiting" - close medical follow up approximately every 3 months - is therefore an appropriate course. If there are multiple lymph nodes measuring >3 cm, or causing symptoms, treatment would be recommended. It is hard to know if your fatigue and weight loss are coming from the lymphoma, they may be. It is very important that you trust your oncologist. This diagnosis, in particular, is best managed in partnership. As there is no single clear superior medical course, you need to understand your options and make an informed medical decision that is best for you, including for your peace of mind. Also, as this is a rare kind of NHL, it might be a good idea to seek care at a tertiary care center, with an oncologist who works primarily with lymphoma.

Q : 11

Is stem cell transplantation indicated as a first line treatment for diffuse large B cell NHL. My son is newly diagnosed but not staged or graded yet. He is 29 years old.

Generally, Diffuse Large B-cell Lymphoma has a high cure rate with standard therapy, and we do not consider stem cell transplant just yet. We treat with standard therapy, and hope that he will be cured. If the standard treatment fails, we proceed to a second treatment, which should be followed by transplant.

Q : 12

Is Non-Hodgkin's lymphoma genetic and do my children have a risk of it, considering my father and my mother-in-law both lost their battles with it?

There is no strong evidence that NHL is genetic. In most cases, we don't understand where it comes from or why it happens. Chronic infection, immunosuppression and pesticide exposure seem to play a role in the development of some lymphomas. Some of the lifestyle choices that provide protection from heart disease also seem to provide some protection from development of cancer like eating fresh food and staying fit.

Q : 13

I had treatment for NHL and most my recent scan came back OK. However, I am having pain in my knees and fingers. I am 43 years old and it has been two months since my last treatment. I had monoclonal antibody therapy and chemo.

I'm glad that your NHL has responded to treatment. Do you also have pain in your feet? You may have neuropathic pain - a result of nerve damage from one of the chemotherapy agents. This kind of pain starts later in treatment, after cycle 4, 5 or 6 of chemotherapy. Most patients describe it as pins and needles, or numbness, or pain. For many it is worst in the morning, some describe it as heaviness or coldnness. It can improve, particularly over the first year after chemotherapy. There are some medications that are particularly helpful for neuropathic pain. You should talk about this problem with your oncologist, who would be seeing you at least once every 3-4 months for the first 1-2 years after treatment.

Q : 14

What is the best treatment for a Classical Hodgkin Lymphoma, stage 2b, subtype: nodular sclerosis?

The German Hodgkin Study Group has defined some very nice regimens that use ABVD and radiation together, to cure stage 2b HD. The exact # of cycles depend upon some of your lab values.

Q : 15

I found a lump in my groin the other day and it's a little painful. Is it possible to have lymphoma and not have all the other symptoms?

Yes, early stage lymphoma often comes without the systemic symptoms. Your lymph node may be enlarged and tender due to a recent infection. If so, it will get smaller over the next week or so. But you are at risk of another lymphoma. A core or excisional biopsy really would be a good idea. The Leukemia and Lymphoma Society may have resources available to you.

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