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The Wake Forest Baptist Approach 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. 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.   Non-Hodgkin's lymphoma Lymphoma, malignant - CT scan Immune system structures Definition: Non-Hodgkin's lymphoma is cancer that starts in the lymphoid tissue. Such tissue makes up the lymph nodes, spleen, and other organs of the immune system. Alternative Names: Lymphoma - non-Hodgkin's; Lymphocytic lymphoma; Histiocytic lymphoma; Lymphoblastic lymphoma; Cancer - non-Hodgkin's lymphoma Causes, incidence, and risk factors: White blood cells called lymphocytes are found in lymph tissues. Most lymphomas start in a type of white blood cells called B lymphocytes. For most patients, the cause of the cancer is unknown. However, lymphomas may develop in people with weakened immune systems. For example, after an organ transplant. Non-Hodgkin's lymphoma is grouped, or staged, according to how fast the cancer spreads. The cancer may be low grade, intermediate grade or high grade. Burkitt's tumor is an example of a high-grade lymphoma. There are many different types of non-Hodgkin's lymphoma. According to the American Cancer Society, a person has a 1 in 50 chance of developing non-Hodgkin's lymphoma. Most of the time, this cancer affects adults. However, children can get some forms of CLL. High-risk groups include those who have received an organ transplant or who have a weakened immune system (immunosuppression). The cancer is more common in men than women. Symptoms: Non-Hodgkin's lymphoma can cause a variety of symptoms. Symptoms depend on what area of the body is affected by the cancer. Symptoms may include: Swollen lymph nodes in the neck, underarms, groin, or other areas (may occur as an armpit lump) Fever Excessive sweating with night sweats Unintentional weight loss Severe itchiness Coughing or shortness of breath may occur if the cancer affects the thymus gland or lymph nodes in the chest, which puts pressure on the windpipe. Some patients may have stomach pain or swelling, which may lead to a loss of appetite, constipation, nausea, and vomiting. If the cancer affects cells in the brain, the person may have a headache, concentration problems, personality changes, or seizures. Signs and tests: The doctor will perform a physical exam and feel lymph nodes to see if they are swollen. Tests to diagnose and stage non-Hodgkin's lymphoma include: Lymph node biopsy Bone marrow biopsy CBC with differential CT scans of the chest, abdomen and pelvis Blood chemistry tests X-rays PET (positron emission tomography) scan Treatment: Treatment depends on how quickly the cancer spreads, the stage of the cancer when you are first diagnosed, and symptoms. Chemotherapy is commonly used. A drug called rituximab (Rituxan) is often used to treat non-Hodgkin's lymphoma. Rituxan is a form of immunotherapy. Radioimmunotherapy may be used in some cases. This involves linking a radioactive substance with an antibody that helps the immune system fight infection, and injecting the substance into the body. In select cases, a stem cell transplant may be needed. Support Groups: The stress of illness may be eased by joining a support group whose members share common experiences and problems. See cancer - support group. Expectations (prognosis): Low-grade non-Hodgkin's lymphoma can not be cured with chemotherapy. However, the low-grade form of this cancer progresses slowly, and it may take more than 10 years before the disease gets worse. Chemotherapy can help cure high-grade lymphoma. However, if the cancer does not respond to chemotherapy drugs, the disease can cause rapid death. Complications: Infection Autoimmune hemolytic anemia Calling your health care provider: Call your health care provider if symptoms of this disorder develop. If you have non-Hodgkin's lymphoma, call your health care provider if you experience persistent fever or other signs of infection. References: American Cancer Society. Cancer Facts and Figures 2006. Atlanta, GA: American Cancer Society; 2006. Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKena WG. Clinical Oncology. 3rd ed. Orlando, Fl: Churchill Livingstone; 2004: 2985-3014.

Review Date:9/11/2006 Reviewed By:Corey Cutler, MD, MPH, FRCP(C), Assistant Professor of Medicine, Harvard Medical School; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA. Review provided by VeriMed Healthcare Network.