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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 of the lymphoid tissue, which includes 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, or B cells. For most patients, the cause of this cancer is unknown. However, lymphomas may develop in people with weakened immune systems. For example, the risk of lymphoma increases after an organ transplant or in people with HIV infection. Non-Hodgkin's lymphoma is classified 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 lymphoma. High-risk groups include those who have received an organ transplant or who have a weakened immune system (immunosuppression). This type of cancer is more common in men than in 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: Excessive sweating, especially while sleeping at night Fever Severe itchiness Swollen lymph nodes in the neck, underarms, groin, or other areas Unintentional weight loss 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 (trachea) or other airways. Some patients may have abdominal 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 check body areas with lymph nodes to feel if they are swollen. Tests to diagnose and stage non-Hodgkin's lymphoma include: Blood chemistry tests Bone marrow aspiration and biopsy CBC with white blood cell differential CT scans of the chest, abdomen and pelvis Lymph node biopsy PET (positron emission tomography) scan X-rays Treatment: Treatment depends on how quickly the cancer spreads, the stage of the cancer when you are first diagnosed, and any symptoms. Chemotherapy is commonly used as the main form of treatment. Another drug, called rituximab (Rituxan), is often used to treat non-Hodgkin's lymphoma. Rituxan is a form of immunotherapy. It targets a molecule on the surface of B-cells. Radioimmunotherapy may be used in some cases. This involves linking a radioactive substance to an antibody that helps the immune system fight infection, and injecting the substance into the body. In select cases, a stem cell or bone marrow 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't be cured with chemotherapy alone. 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: Autoimmune hemolytic anemia Infection Calling your health care provider: Call your health care provider if you develop symptoms of this disorder. If you have non-Hodgkin's lymphoma, call your health care provider if you experience persistent fever or other signs of infection. References: Bierman P, Harris N, Armitage J. Non-Hodgkin's lymphomas. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 196. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Non-Hodgkin's Lymphomas. National Comprehensive Cancer Network; 2009. Version 2.2009.

Review Date:2/12/2009 Reviewed By:David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.