HL. Hodgkin lymphoma is a cancer of the lymph nodes that often starts in the chest, neck, or abdomen. It occurs in all age groups, but is most common in early adulthood (61% of cases are diagnosed between ages 15 and 49, Figure 2, page 4). There are two major types of HL: classic, which is the most common and is distinguishable by the presence of Reed Sternberg cells, and nodular lymphocyte predominant, which is rare and tends to be more slow growing than classic HL.
Treatment varies slightly by type. Classical Hodgkin disease is generally treated with multi-agent chemotherapy often along with radiation therapy. Stem cell transplant may also be recommended for some patients. Brentuximab vedotin (Adcetris) was recently approved to treat HL in certain patients who failed to respond to previous therapies.
For those diagnosed with nodular lymphocyte predominant HL, radiation alone may be appropriate for patients with early stage disease. For those with later-stage disease, chemotherapy plus radiation, as well as the monoclonal antibody rituximab (Rituxan), may be recommended.
Survival rates have improved substantially since the early 1970s. During the most recent time period, the 1-year relative survival rate for all patients diagnosed with Hodgkin disease was 92%; the 5- and 10-year rates were 84% and 79%, respectively.
NHL. The most common types of NHL are diffuse large B-cell lymphoma, representing about one-third of NHL cases, and follicular lymphoma, which represents about one-fifth of NHL cases. Diffuse large B-cell lymphomas grow quickly, yet about half of all patients are cured with treatment. It can affect any age group, but occurs most often in adults ages 50 and older. In con-trast, follicular lymphomas tend to grow slowly and often do not require treatment until the lymphoma causes symptoms. Although standard treatment will not usually cure this cancer, patients may still live a long time. The overall 5-year relative survival rate is 67%.7 Over time, some follicular lymphomas change into the fast-growing diffuse B-cell type. NHL is usually treated with chemotherapy either in combina¬tion with radiation (11%) or without radiation (56%); radiation without chemotherapy (7%) is used less often (Figure 9). Tar¬geted therapies such as rituximab (Rituxan), alemtuzumab (Campath), and ofatumumab (Arzerra) are also used for some types of NHL.
Special concerns of leukemia and lymphoma survivors: Treatments for leukemia and lymphoma can result in a number of significant late effects. Some children with ALL may receive cranial radiation therapy to treat any spread of leukemia to the central nervous system (CNS), which can cause long-term cognitive deficits. Young women treated in childhood with radiation to the chest for Hodgkin lymphoma are at increased risk for developing breast cancer. This type of radiation is also associated with increased risk of various heart complications (e.g., valvular heart disease and coronary artery disease), which can occur decades after treatment is received.
Several forms of leukemia and lymphoma in adults involve long periods of slow progression or remission with the likelihood of eventual accelerated disease or recurrence. While most welcome this period of relatively healthy survivorship, it may pose unique challenges to patients and their loved ones due to anxiety about eventual outcomes.