This is the seventh in a series of instalments devoted to breakthroughs for the more common solid and blood cancers; this week is dedicated to Non-Hodgkin’s Lymphoma (NHL).

The lymphatic system is made up of very narrow interconnecting vessels found throughout the body and facilitates the drainage of lymphatic fluid from the tissues into the bloodstream. The lymphatic system is punctuated with 100s of lymph nodes. These bean-shaped structures filter the lymphatic fluid before it can enter the bloodstream. Within these lymph nodes there is a specialized white blood cell, the lymphocyte, which is an integral part of our immune system and is responsible for fighting and destroying germs and diseases.

NHL arises in the lymphatic system.

In NHL the lymphocytes grow abnormally resulting in the enlargement of lymph nodes in various areas of the body. NHL is an umbrella term for a range of lymphomas. These are separate and distinct from Hodgkin’s lymphoma. While NHL affects adults primarily, however, children can sometimes be affected. NHL can involve the spleen, bone marrow, thymus, tonsils, adenoids, and parts of the gastrointestinal tract. Uncommonly, it involves the skin. It is important that the specific subtypes of NHL be identified in order to determine the specific treatment that is required. NHLs are also classified based on their aggressiveness. At one end of the spectrum is an extremely slow-growing variety, referred to as indolent, whereas at the other end is the aggressive large B cell lymphoma while there are NHLs that are mid-range.

Predisposing factors for the development of NHL include advancing age, being male, being white, family history, exposure to certain environmental chemicals (e.g. herbicides, insecticides, benzine), possibly methotrexate, autoimmune diseases (e.g. rheumatoid arthritis, SLE. Celiac), previous chemo and radiotherapy, a range of infections – Epstein-Barr, H. Pylori, HIV, HTLV-1 (endemic in the Caribbean) and Hepatitis C, being overweight, and some breast implant recipients.
There is no single way to prevent NHL, however, maintaining a robust immune system through a healthy lifestyle, diet, and exercise helps. Other means of reducing one’s chance of developing NHL include limiting exposure to HIV, treating H. Pylori, reducing the spread of HTLV-1, especially here in the Caribbean, minimizing the use of certain chemotherapeutic agents, and controlling weight.

Some recent discoveries and advancements regarding NHL:

• New and improved genetic testing allows doctors to determine the DNA fingerprint of any given patient’s NHL. This then helps to fine-tune the subtype’s treatment.
• Targeted therapies using monoclonal antibodies (e.g. brentuximab, moxetumomab), kinase inhibitors (e.g. copanlisib, idelalisib, duvelisib), and immunomodulatory treatments are increasingly being used. For example, laboratory-made monoclonal antibodies are infused into the body in order to specifically destroy lymphoma tissue while sparing healthy tissue.
• Chimeric Antigen Receptor T-therapy is a cutting-edge form of immunotherapy whereby the body’s own T cells are removed from the body, modified in the lab, then reintroduced into the body so that they can precisely attack the NHL cells
• Immune checkpoint inhibitors (e.g. pembrolizumab) enhance the body’s T-cells to kill NHL cells.
• An in situ vaccine is being developed to destroy NHL. An advantage of this vaccine is that it has very few side effects.

Recently diagnosed NHL patients should attend their doctor with a close family member or friend, and below are some questions that need to be asked:

• What type of NHL do I have?
• Is there any benefit to sending my biopsy overseas to a centre specializing in NHL?
• Are any other tests needed before a decision is made on my specific treatment?
• What is the stage and grade of my NHL? What is the prognosis?
• Does my NHL require immediate treatment?
• What are all the treatment options? Are all available locally? If not, what’s not?
• What are the goals and likely success of my treatment?
• Can copies of all the reports be provided?
• Is there any additional treatment that can be beneficial even if it means having to travel or pay to bring it into the country?
• Are other doctors going to be involved in my treatment?
• What are the possible side effects of the proposed treatments?
• Is a second opinion locally or overseas recommended or worth pursuing?

Stomach cancer will be covered next Friday.

Author: Dr. C. Malcolm Grant – Family Physician, c/o Family Care Clinic, Arnos Vale. For appointments: clinic@familycaresvg.com, 1(784)570-9300, (Office), 1(784)455-0376
(WhatsApp)
Disclaimer: The information provided in the above article is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you are seeking medical advice, diagnoses, or treatment.
Dr. C. Malcolm Grant, Family Care Clinic or The Searchlight Newspaper, or their associates, respectively, are not liable for risks or issues associated with using or acting upon the information provided above.