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Treatment Guide
Lymphoma
What is lymphoma?
Lymphoma is a disease that develops in lymphoid tissue,
which is found in the lymph nodes, lymph vessels and in
lymph itself. Lymph is a watery fluid that carries waste
products and excess fluid away from tissues. It travels through
the body in a network of vessels called the lymph system.
Located throughout this network are lymph nodes, which filter
and store white blood cells, called lymphocytes. Lymphocytes
help fight infection. Lymphoid tissue also is found in the
tonsils, spleen, liver, thymus gland and many other parts of the
body. Lymphoma generally arises from one of the two major
types of lymphocytes: B cells and T cells.
Because lymph tissue is found throughout the body, lymphoma
can start anywhere and spread to any organ. The liver, bone
marrow and spleen often are involved.
There are two main types of lymphoma: Hodgkin and nonHodgkin, although there are many subtypes of both.
Hodgkin lymphoma (or Hodgkin’s disease) – This type tends to
occur in the 15- to 40-year-old age group. It most commonly
affects the lymph nodes in the neck, armpits and center of the
chest (mediastinum).
Non-Hodgkin lymphoma – This type can occur at any age, but
primarily affects people in their 60s, 70s and 80s.
The causes of lymphoma are mostly unknown. Some
viral infections increase the risk of developing lymphoma
(hepatitis C and HIV are examples). Some other infections
and inflammatory conditions also appear to increase the
risk. People with immune disorders and those taking
immunosuppressant drugs — the kind used after organ
transplantation — also are at slightly higher risk for developing
this disease.
USING THIS GUIDE
Please use this guide as a resource as you examine your
treatment options. Remember, it is every patient’s right to ask
questions, and to seek a second opinion.
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CLEVELAND CLINIC CANCER CENTER | LYMPHOMA | TREATMENT GUIDE
How is lymphoma diagnosed?
The first step in diagnosing lymphoma is a physical examination, in which your
doctor will look for enlarged lymph nodes and unusual areas of swelling. Blood
tests will be done to check the number of blood cells and liver and kidney function. A CT scan of your chest, abdomen and pelvis, or a PET scan may be taken to
look for enlarged lymph nodes, liver or spleen.
Microscopic images
of white blood cells
Submandibular
lymph nodes
Cervial
lymph
nodes
B Lymphocyte
Thymus gland
Axillary
lymph
nodes
T Lymphocyte
The only way to confirm a diagnosis of lymphoma is by a biopsy of tissue from an
affected area, which is usually a lymph node. This biopsy should be reviewed by a
pathologist expert in lymphoma, as there are many types of lymphoma and selecting
the best treatment depends on an accurate diagnosis. All patients who come to us
for evaluation have their pathology slides reviewed by our lymphoma pathologists.
Spleen
Inguinal
lymph
nodes
How is lymphoma treated?
Patients with many forms of lymphoma have excellent outcomes. In fact, more
than 90 percent of patients with Hodgkin lymphoma have disease that goes into
remission. Standard treatments for lymphoma include:
Chemotherapy – Used to kill malignant cells throughout the body. Most chemotherapy drugs for lymphoma are given intravenously (through a vein), and patients
can receive the drugs as outpatients. Only occasionally do patients need intensive
chemotherapy in the hospital.
2012
Targeted therapy – Delivering drugs, toxins or radioactive materials directly to
cancer cells and targets within cancer cells to kill the cells, stop their growth or
prevent them from spreading. It is often used in conjunction with chemotherapy,
and can improve cure rates. The most common monoclonal antibody agent used
for non-Hodgkin lymphoma is rituximab. For Hodgkin lymphoma, an antibody that
delivers a drug right to the lymphoma is an effective treatment in cases that have
relapsed. Therapies that enhance the immune system are also under investigation,
and some are already in use.
Radiation therapy – A form of targeted X-ray treatment that is sometimes used to
treat affected lymph nodes.
Stem cell transplantation – A way of delivering high-dose chemotherapy, usually
followed by reinfusing the patient’s own stem cells (or sometimes donor stem
cells), to more effectively treat the lymphoma. New treatments are being explored
that modify the patient’s own immune cells to attack the lymphoma. These cells
are then reinfused.
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PERSONALIZED CARE PLANS
Because the best treatment for lymphoma depends primarily upon its subtype,
the physicians and nurses involved in your treatment will meet to decide which
of the standard treatments above are right for you. They will design a treatment
plan that will provide the greatest likelihood of disease remission with the lowest
impact on your everyday life.
Here is a closer look at what a sample customized treatment plan might include:
Hodgkin lymphoma – Treatment depends on the size of the tumors, the extent
of the lymphoma (stage) and your symptoms. Standard treatment involves chemotherapy, radiation therapy or both. If you are experiencing a relapse of the
disease, a stem cell transplant can be highly effective in achieving remission.
Non-Hodgkin lymphoma – Treatment usually includes chemotherapy + an
antibody, and might include radiation, targeted therapy, stem cell transplantation
or a combination of these. The two main groups are aggressive and indolent.
Aggressive lymphomas are often cured with the proper therapy. Indolent
lymphomas can be controlled for many years and sometimes, no treatment is
necessary for these slow-growing types.
Can I participate in a clinical trial?
Many clinical trials of new treatments or combinations of treatments are available for patients with Hodgkin and non-Hodgkin lymphoma. If your Cleveland
Clinic oncologist feels you might benefit from participating in a clinical trial, the
options will be discussed with you in detail.
Bone marrow transplant
Cleveland Clinic has been
performing bone marrow
transplants for over 35 years,
and its program is internationally
recognized and accredited. Several
types of transplants are offered.
The best option depends on the
type of lymphoma you have. For
more information, please visit:
clevelandclinic.org/bonemarrow
HOW DOES THE CLINICAL TRIALS PROCESS WORK?
Clinical trials can help a wide range of patients — from those who are newly
diagnosed to those for whom conventional treatment has failed. In fact, there
are instances when they may offer the best chance of disease remission over
standard therapy. If you are willing to consider a clinical trial, your physician will
then weigh many factors, including:
WILL THE PARTICULAR TRIAL BENEFIT YOU?
Do you meet the eligibility criteria for the trial? (Factors may include age, the
type of lymphoma, how many other treatments you’ve had, additional health
conditions you have, and particular lab results needed.
For example, consider this: There are more than 40 types of non-Hodgkin lymphoma and some are treated quite differently. Even within the same subtype,
diffuse large B cell, for example, you could have patients who express a certain
protein or not — which would make them eligible or ineligible for a specific study.
Talk to your physician any time you have questions about whether you may
benefit from a clinical trial. A list of our open trials can be found at
clevelandclinic.org/cancerclinicaltrials.
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CLEVELAND CLINIC CANCER CENTER | LYMPHOMA | TREATMENT GUIDE
Why should I choose Cleveland Clinic?
Cleveland Clinic Cancer Center is dedicated to providing exceptional care and
support to individuals with cancer. More than 400 cancer specialists, nurses and
technicians work together to best meet your unique needs. Our cancer program is
top-ranked in Ohio and #8 in the country according to U.S. News & World Report.
A TEAM APPROACH
Our physicians and nurses involved in treating lymphoma meet weekly to discuss
each patient’s plan, progress and make decisions, such as whether to recommend stem cell transplantation. This means everyone treated at Cleveland Clinic
receives the input of the entire team.
We will take into consideration your goals and your desire for quality of life as well
of length of life. You can be assured you will receive the most advanced, most
patient-friendly treatment possible.
OUR SPECIALISTS
We offer a team of specialists solely dedicated to treating lymphoma. To find a
physician, visit clevelandclinic.org/staff or call 866.223.8100.
FACILITIES SECOND TO NONE
If you have lymphoma and need a stem cell or bone marrow transplant, there’s a
chance you will need to spend three to six weeks in the hospital. We make every
effort to make our hospital feel like your home away from home, so the experience
will be as comfortable as possible.
Our two dedicated 22-bed units are designed to meet the unique clinical and
emotional needs of lymphoma and stem cell or bone marrow transplant patients.
Large, private rooms feature pull-out beds for family members, wireless Internet, flat screen TVs with built-in DVD players and expansive windows. The units
include amenities such as computers, an exercise room, a washer and dryer,
kitchen and lounge areas.
The special floor is not only more comfortable, it also is equipped to ensure the
best patient care. The contained unit has the latest air handling system to minimize infection in patients whose immune systems are not functioning at their
best. The system continually filters the air on the floor, removing 99.98 percent of
potential pollutants.
© Russell Lee 2012
Choosing your cancer care
The prognosis for many patients
with lymphoma is very good.
Today, most people who develop
Hodgkin lymphoma, and many
who develop non-Hodgkin
lymphoma, have excellent
outcomes. While you have many
options for the treatment of
lymphoma, you should consider the
experience of the program when
selecting where to seek care.
Cleveland Clinic Cancer Center
specialists explore all options and
tailor the most appropriate plan
for each patient with lymphoma
– offering the greatest chance of
achieving disease remission and
living a long and healthy life.
Our cancer program is top-ranked
in Ohio and #8 in the country
according to U.S. News &
World Report.
SUPPORT EVERY STEP OF THE WAY
Cancer care doesn’t end after treatment. Survivorship requires your being followed
regularly to watch for potential situations that may occur, such as recurrences or
side effects from treatment.
As a survivor, you may find it comforting to know that your Cleveland Clinic
oncologist is dedicated to continuing to provide your follow up care for years
to come. If you live out of town or move away, we understand this may not be
possible. In these cases, we will be happy to coordinate your care with a doctor at
one of our 16 Northern Ohio locations or a physician closer to home.
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CLEVELAND CLINIC CANCER CENTER | LYMPHOMA | TREATMENT GUIDE
We care about young adults
We recognize that young adults facing cancer care experience specific problems
and challenges that are different than those of older adults. You can be assured
that the members of your cancer team at Cleveland Clinic are aware of these
concerns and will help you work through them. You should feel free to raise any
concerns you have with your oncologist at any time. Knowing who will be taking
care of you, what will happen during your treatment, and how you are likely to
be affected by the treatment will help you face your challenge with optimism and
enable you to continue living as normal a life as possible.
Contacting Cleveland Clinic
Still have questions? Call our Cancer Answer Line.
Oncology clinical nurse specialists and
their staff can provide information and
answer questions about cancer.
We are here to help you get the cancer information you need. Please contact
Cleveland Clinic Cancer Answer Line toll-free at 866.223.8100. Oncology clinical
nurse specialists and their staff provide information and answer questions about
cancer. The Cancer Answer Line operates from 8 a.m. to 5 p.m., Monday-Friday.
Ready to schedule an appointment?
If you would like to set up a consultation with a Cleveland Clinic specialist, please
call the Cancer Answer Line toll-free at 866.223.8100.
Making your care easier
Support Services
The life-changing events that occur when you or a loved one is diagnosed with
cancer are challenging. Cleveland Clinic Cancer Center offers many services and
programs to help you navigate those changes while promoting your well-being.
Services include the 4th Angel Mentoring Program, educational resources, psychosocial programs, support groups, financial services, free wigs and a variety of
wellness programs. For a complete list of programs and locations, visit
clevelandclinic.org/cancersupport.
Social work
Social workers at Cleveland Clinic Cancer Center can help you and your loved
ones identify and maximize your strengths in coping with a cancer diagnosis,
treatment and follow-up care. Social workers also assist with employment and
financial issues, and referrals to other community resources. Contact the Cancer
Answer Line at 866.223.8100.
The 4th Angel Mentoring Program
This free program connects patients with a phone mentor who also is a cancer
survivor. Matches are made based on diagnosis and age. Mentors who are
cancer survivors can provide a unique perspective and type of support. A
mentoring program also is available for caregivers. Contact: 216.445.8734 or
1.866.520.3197 or visit 4thangel.org.
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CLEVELAND CLINIC CANCER CENTER | LYMPHOMA | TREATMENT GUIDE
Chemocare.com
Available in English and Spanish, this website provides information and videos
about chemotherapy and other anti-cancer drugs, managing side effects, complementary medicine and nutrition.
Medical concierge
If you are traveling from out of state and need any assistance, call the
complimentary Medical Concierge at 800.223.2273, ext. 55580, or email
[email protected].
MyChart®
Cleveland Clinic MyChart® is a secure, online personal healthcare management
tool that connects patients to their medical record. Patients can register for
MyChart through their physician’s office or by going online to
clevelandclinic.org/mychart.
Online resources
More information on lymphoma diagnosis and treatment can be found on
Cleveland Clinic’s websites:
clevelandclinic.org/hodgkinlymphoma
clevelandclinic.org/nonhodgkinlymphoma
Cleveland Clinic oncologists also recommend the following resources:
cancer.net
AAMDS.org
LLS.org
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A New Home for Cancer Care
When you visit Taussig Cancer
Center, Cleveland Clinic’s new
$276 million, 377,000-squarefoot home for cancer care, some
of its features are immediately
apparent: expansive, welcoming
spaces, the abundance of natural
light, and the combination of
clinical care and support services.
A deeper look reveals a facility
designed expressly to improve
patient outcomes through a
collaborative, multidisciplinary
approach to cancer care. The
new cancer building on Cleveland
Clinic’s main campus, with 126
exam rooms and 98 treatment
rooms, incorporates all outpatient
cancer services under one roof.
The building creates a seamless,
personalized experience for
patients and provides easy access
to a variety of support services
intended to reduce cancer’s
psychological stress.
Follow us on Twitter @ClevelandClinic
Explore our services, locations and more at clevelandclinic.org.
Find a wealth of family health & wellness tips at
health.clevelandclinic.org.
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Locations
If you would like to set up a consultation with a Cleveland Clinic cancer
specialist near you, call toll-free 866.223.8100.
CLEVELAND CLINIC CANCER CARE LOCATIONS
LAKE COUNTY
WILLOUGHBY HILLS
Lake Erie
HILLCREST HOSPITAL
BEACHWOOD
GEAUGA COUNTY
LORAIN
SANDUSKY
ELYRIA
RICHARD E. JACOBS
HEALTH CENTER, AVON
NORWALK
CLYDE
SOUTH POINTE HOSPITAL
FAIRVIEW
HOSPITAL
CUYAHOGA COUNTY
INDEPENDENCE
TWINSBURG
STRONGSVILLE
LORAIN COUNTY
SUMMIT COUNTY
PORTAGE COUNTY
MEDINA COUNTY
MEDINA HOSPITAL
CLEVELAND CLINIC CANCER CARE LOCATIONS
ASHLAND COUNTY
WAYNE COUNTY
WOOSTER
MAIN CAMPUS
TAUSSIG CANCER
CENTER
CLEVELAND CLINIC CARE CENTER
REGIONAL HOSPITAL
FAMILY HEALTH CENTER
MANSFIELD
17-CNR-563