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Lymphoma- prognosis, complications, prevention

PROGNOSIS

The outlook for HL is very good. It is one of the most curable cancers. The five-year survival rate after treatment is greater than 80% for adults and greater than 90% for children. As a result of refinements in and more aggressive approaches to therapy, the outlook for NHL has improved significantly in the last few decades. The five-year survival rate after treatment is 63% for adults and up to 90% for children. The addition of immunotherapy to standard treatment for NHLs may further improve survival rates. Many people live with lymphoma in remission for many years after treatment.

Prognostic Factors

Several risk factors have been extensively evaluated and shown to play a role in treatment outcome. For HL, the International Prognostic Index includes the following seven risk factors:

  1. Male sex
  2. Age 45 years or older
  3. Stage IV disease
  4. Albumin (blood test) less then 4.0 g/dL
  5. Hemoglobin less than 10.5 g/dL
  6. Elevated WBC count of 15,000/mL
  7. Low lymphocyte count less than 600/mL or less than 8% of total WBC

The absence of any of the above risk factors is associated with an 84% rate of control of Hodgkin’s disease, whereas the presence of a risk factors is associated with a 77% rate of disease control. The presence of five or more risk factors was associated with a disease control rate of only 42%.

The outcomes for these patients were also determined by the treatment they received, which occurred primarily in the 1980s. Newer treatments for Hodgkin’s lymphoma may improve these predicted outcomes. Furthermore, new treatments are being developed for patients with greater risk factors.

The International Prognostic Index for NHL includes five risk factors:

  1. Age older than 60 years
  2. Stage III or IV disease
  3. High LDH
  4. More than one extranodal site
  5. Poor performance status (as a measure of general health): From these factors, the following risk groups were identified:
  • Low risk: one risk factor, five-year lymphoma-free survival (LFS) of 70%
  • Intermediate risk: two to three risk factors, five-year LFS of 49%-50%
  • Poor risk: four to five risk factors, five-year LFS of 26%

The prognostic models were developed to evaluate groups of patients and are useful in developing therapeutic strategies. It is important to remember that any individual patient might have significantly different results than the above data, which represent statistical results for a patient group.

COMPLICATIONS

Early complications of Hodgkin’s disease and non-Hodgkin’s lymphoma are usually related to therapy. Complications of radiotherapy depend on the radiated volume of tissue, dose administered and the technique employed.

Acute effects of Radiation therapy are usually mild and transient and may include:

  • Dryness of the mouth
  • Changes in taste
  • Pharyngitis
  • Nausea
  • Dry cough
  • Dermatitis
  • Fatigue
  • Lhermitte’s syndrome (6 weeks to 3 months after radiation therapy)
  • Radiation pneumonitis and Pericarditis (delayed complications)

Acute and subacute adverse effects to chemotherapy:

  • Myelosuppression (particularly thrombocytopenia)
  • Susceptibility to infections
  • Infertility
  • Autonomic and peripheral neuropathy
  • Hair loss
  • Nausea and vomiting
  • Fatigue
  • Myelosuppression (particularly neutropenia)

Delayed and long-term complications include:

  • Hypothyroidism secondary to thyroid gland radiation
  • Pericardial fibrosis
  • Focal carcinoma or sarcoma secondary to radiation therapy
  • Sterility
  • Anemia and hematological complications of chemotherapy such as thrombocytopenia
  • Late-appearing infections

LYMPHOMA PREVENTION

There is no known way to prevent lymphoma. A standard recommendation is to avoid the known risk factors for the disease. However, some risk factors for lymphoma are unknown, and therefore impossible to avoid. Infection with viruses such as HIV, EBV, and hepatitis are risk factors that can be avoided with frequent hand washing, practicing safe sex, and by not sharing needles, razors, toothbrushes, and similar personal items that might be contaminated with infected blood or secretions.

Support Groups and Counseling for Lymphoma

Living with lymphoma presents many new challenges for an individual and his or her family and friends.

  1. There may be many worries about how the lymphoma will affect one’s ability to “live a normal life,” that is, to care for family and home, to hold a job, and to continue the friendships and activities one enjoys.
  2. Many people feel anxious and depressed. Some people feel angry and resentful; others feel helpless and defeated.

For most people with lymphoma, talking about their feelings and concerns can be helpful.

  1. Friends and family members can be very supportive. They may be hesitant to offer support until they see how the affected person is coping. If the affected person wishes to talk about his or her concerns, it is important to let them know to do so.
  2. Some people don’t want to “burden” their loved ones, or they prefer talking about their concerns with a more neutral professional. A social worker, counselor, or member of the clergy can be helpful if one wishes to discuss their feelings and concerns about having lymphoma. The treating hematologist or oncologist should be able to recommend someone.
  3. Many people with lymphoma are helped profoundly by talking to other people who have lymphoma. Sharing such concerns with others who have been through the same thing can be remarkably reassuring. Support groups of people with lymphoma may be available through the medical center where one is receiving treatment.

 

In fact, MOPP therapy, which was widely used up until recently, has been discontinued in many cancer clinics due to its association with myelosuppression (particularly thrombocytopenia), susceptibility to infections, infertility and autonomic and peripheral neuropathy. The current “gold standard” chemotherapy, is better tolerated although associated with hair loss, nausea and vomiting, fatigue and myelosuppression (particularly neutropenia).

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