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The Wake Forest Baptist Approach Blood and Marrow and Stem Cell Transplantation The Blood and Marrow Transplant (BMT) Program has achieved national renown since opening in 1990. It is the most active adult BMT Program in North Carolina. The complex transplantation procedure uses stem cells isolated in marrow and blood, either from a compatible donor (related or unrelated) or the patient’s own bone marrow. In addition to the use of transplantation for the treatment of acute and chronic leukemias, we are utilizing transplantation as an important means of treating non-Hodgkin’s lymphoma, Hodgkin’s disease, multiple myeloma, and other forms of cancer. In addition, our Program is the second largest Collection Center in the United States for the National Marrow Donor Program. Members of the Transplant Program have been active participants in clinical trials sponsored by the National Heart, Lung and Blood Institute, as well as clinical trials through the Cancer and Leukemia Group B (CALGB), a national cooperative group for clinical trials research supported by the National Cancer Institute. Leukemia and Lymphomas Our Leukemia Program, which began in 1986, is widely recognized for excellence in patient care, teaching and clinical research. As one of the largest adult leukemia services in the Southeast, we are active in national research studies. Active collaboration between basic science laboratory research faculty and our own clinical researchers ensures that patients are offered cutting edge therapies. Among the research studies currently underway is a clinical trial evaluating the use of arsenic trioxide as part of a front line therapy for patients with acute promyelocytic leukemia (APL), a subtype that accounts for approximately 10 percent of all acute myeloid leukemia.  This research study is sponsored by Cancer and Leukemia Group B (CALGB), one of three major adult national cancer research groups. In addition to access to the latest treatments, some of the multidisciplinary services offered for our leukemia patients are nutritional consults, recreational therapy, pastoral care services and the Cancer Patient Support Program. Additionally, our oncology staff works with patients and families to identify support and resources in their home communities. Lymphomas, including Hodgkin’s Disease and the array of non-Hodgkin’s lymphomas, represent a growing area of clinical interest at the Comprehensive Cancer Center. Treatment ranges from standard “treatment guideline” protocols to local and national research trials investigating cutting edge therapies. One particular area of emphasis is dose-intensive therapy followed by either bone marrow or peripheral stem cell transplantation.   Hodgkin’s lymphoma Lymphatic system Lymphoma, malignant - CT scan Hodgkin's disease, liver involvement Immune system structures   Definition: Hodgkin's lymphoma is a malignancy (cancer) of lymph tissue found in the lymph nodes, spleen, liver, and bone marrow. Alternative Names: Lymphoma - Hodgkin's; Hodgkin's disease; Cancer - Hodgkin's lymphoma Causes, incidence, and risk factors: The first sign of this cancer is often an enlarged lymph node which appears without a known cause. The disease can spread to nearby lymph nodes and later may spread to the lungs, liver, or bone marrow. The cause is not known. Hodgkin's lymphoma is most common among people 15 to 35 and 50 to 70 years old. Symptoms: Painless swelling of the lymph nodes in the neck, armpits, or groin (swollen glands) Fatigue Fever and chills Night sweats Weight loss Loss of appetite Generalized itching Additional symptoms that may be associated with this disease: Excessive sweating Skin blushing or flushing Neck pain Hair loss Flank pain Clubbing of the fingers or toes Splenomegaly Signs and tests: The disease may be diagnosed after: A lymph node biopsy A bone marrow biopsy A biopsy of suspected tissue Detection of Reed-Sternberg (Hodgkin's lymphoma) cells by biopsy A staging evaluation (tumor staging) may be done to determine the extent of the disease. The following procedures may be done: Physical examination CT scans of the chest, abdomen, and pelvis Bone marrow biopsy Blood chemistry tests PET scan   In some cases, abdominal surgery to take a piece of the liver and remove the spleen may be needed. However, because the other tests are now so good at detecting the spread of Hodgkin's lymphoma, this surgery is usually unnecessary. Hodgkin's lymphoma may change the results of the following tests: Lymphocyte count Small bowel biopsy Schirmer's test Peritoneal fluid analysis Mediastinoscopy with biopsy Gallium scan Ferritin Cytology exam of pleural fluid Cryoglobulins Bone marrow aspiration Blood differential ACE levels Treatment: A staging evaluation is necessary to determine the treatment plan. Stage I indicates one lymph node region is involved (for example, the right neck). Stage II indicates involvement of 2 lymph nodes on the same side of the diaphragm (for example, both sides of the neck). Stage III indicates lymph node involvement on both sides of the diaphragm (for example, groin and armpit). Stage IV involves the spread of cancer outside the lymph nodes (for example, to bone marrow, lungs, or liver). Treatment varies with the stage of the disease. Stages I and II (limited disease) can be treated with localized radiation therapy, with chemotherapy or with a combination of both. Stages III and IV (extensive disease) are treated with chemotherapy alone or a combination of radiation therapy and chemotherapy. The best treatment for an individual patient depends on many factors, and should be discussed in detail with a doctor who has experience treating this disease. Chemotherapy can cause low blood cell counts, which can lead to an increased risk of bleeding, infection, and anemia. To minimize bleeding, apply ice and pressure to any external bleeding. A soft toothbrush and electric razor should be used for personal hygiene. Infection should always be taken seriously during cancer treatment, so contact your doctor immediately if fever or other signs of infection develop. Planning daily activities with scheduled rest periods may help prevent fatigue associated with anemia. Support Groups: The stress of illness can often be eased by joining a support group of people sharing common experiences and problems. See cancer - support group. Expectations (prognosis): With appropriate treatment, more than 80% of people with stage I or II Hodgkin's survive for at least 10 years. With widespread disease, the treatment is more intense and the 5-year survival rate is about 60%. Complications: Other cancers Lung problems Liver failure Adverse effects of radiation and chemotherapy Inability to have children (sterility) Calling your health care provider: Call your health care provider if you have symptoms suggestive of Hodgkin's lymphoma. Call your health care provider if you are being treated for Hodgkin's lymphoma and experience adverse effects of radiation and chemotherapy, including nausea, loss of appetite, vomiting, diarrhea, fever, or bleeding.

Review Date:5/3/2006 Reviewed By:William Matsui, MD, Assistant Professor of Oncology, Division of Hematologic Malignancies, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD. Review provided by VeriMed Healthcare Network.