AIDS-related lymphoma

Table of Contents

DESCRIPTION

What is AIDS-related lymphoma?

STAGE EXPLANATION

Stages of AIDS-related lymphoma

Systemic/peripheral lymphoma

Primary central nervous system lymphoma

TREATMENT OPTION OVERVIEW

How AIDS-related lymphoma is treated

AIDS-RELATED PERIPHERAL/SYSTEMIC LYMPHOMA

AIDS-RELATED PRIMARY CNS LYMPHOMA

DESCRIPTION

AIDS-related lymphoma is a disease in which cancer (malignant) cells are found in the lymph system in patients who have AIDS (acquired immunodeficiency syndrome). AIDS is caused by the human immunodeficiency virus (HIV) which attacks and weakens the immune system. Infections and other diseases can then invade the body, and the immune system cannot fight against them.

The lymph system is made up of thin tubes that branch, like blood vessels, into all parts of the body. Lymph vessels carry lymph, a colorless, watery fluid that contains white blood cells called lymphocytes. Along the network of vessels are groups of small, bean-shaped organs called lymph nodes. Clusters of lymph nodes make and store infection-fighting cells. The spleen (an organ in the upper abdomen that makes lymphocytes and filters old blood cells from the blood), the thymus (a small organ beneath the breastbone), and the tonsils (an organ in the throat) are also part of the lymph system. Because there is lymph tissue in many parts of the body, the cancer can spread to almost any of the body's organs or tissues including the liver, bone marrow (the spongy tissue inside the large bones of the body that makes blood cells), spleen, or brain.

Lymphomas are divided into two general types, Hodgkin's disease and non-Hodgkin's lymphomas, which are classified by the way their cells look under a microscope. This determination is called the histology. Histology is also used to determine the type of non-Hodgkin's lymphoma of which there are ten. They types of non-Hodgkin's lymphomas are classified by how quickly they spread: low-grade, intermediate-grade, or high-grade. The intermediate- or high-grade lymphomas grow and spread faster than the low-grade lymphomas.

Both major types of lymphoma, Hodgkin's disease and non-Hodgkin's lymphoma, may occur in AIDS patients. Also, the intermediate-and high-grade types of non- Hodgkin's lymphoma are more commonly found in AIDS patients. Both types of lymphomas can also ocur in adults and in children (For further information about these types of lymphomas in persons who do not have AIDS, please see the PDQ patient information summaries on Hodgkin's and non-Hodgkin's lymphomas in adulthood or childhood).

A doctor should be seen if any of the following symptoms persist for longer than 2 weeks: painless swelling in the lymph nodes in the neck, underarm, or groin; fever; night sweats; tiredness; weight loss without dieting; or itchy skin.

If a patient has AIDS and symptoms of lymphoma, a doctor will carefully check for swelling or lumps in the neck, underarms, and groin. If the lymph nodes don't feel normal, the doctor may need to cut out a small piece of tissue and look at it under the microscope to see if there are any cancer cells. This procedure is called a biopsy.

In general, patients with AIDS-related lymphoma respond to treatment differently from patients with lymphoma who do not have AIDS. AIDS-related lymphoma usually grows faster and spreads outside the lymph nodes and to other parts of the body more often than lymphoma that is not related to AIDS. Because therapy can damage weak immune systems even further, patients who have AIDS-related lymphoma are generally treated with lower doses of drugs than patients who do not have AIDS.

STAGE EXPLANATION

Once AIDS-related lymphoma is found, more tests will be done to find out if the cancer has spread from where it started to other parts of the body. This testing is called staging. The stage of a disease, ranging from stage I to stage IV, gives an indication of how far the disease has spread. To plan treatment, a doctor needs to know the stage of the disease.

The doctor may determine the stage of the disease by conducting a thorough examination which may include blood tests and different kinds of x-rays. This testing is called clinical staging. In some cases, the doctor may need to do an operation called a laparotomy to determine the stage of the cancer. During this operation, the doctor cuts into the abdomen and carefully looks at the organs to see if they contain cancer. The doctor will cut out (biopsy) small pieces of tissue and look at them under a microscope to see whether they contain cancer. This type of staging is called pathologic staging. Pathologic staging is usually done only when it is needed to help the doctor plan treatment.

For treatment, AIDS-related lymphomas are grouped based on where they started, as follows:

Lymphoma that has started in lymph nodes or other organs of the lymph system. The lymphoma may have spread from where it started throughout the body, including to the brain or bone marrow.

Lymphoma that has started in the brain or spinal cord, both of which are part of the central nervous system (CNS). This type of lymphoma is called a "primary CNS lymphoma" because it starts in the CNS rather than starting somewhere else in the body and spreading to the CNS.

TREATMENT OPTION OVERVIEW

The treatment of AIDS-related lymphoma is difficult because of the problems caused by HIV infection, which weakens the immune system. The drug doses used are often lower than drug doses given to patients who do not have AIDS. Two types of treatment are used:

• chemotherapy (using drugs to kill cancer cells and shrink tumors)
• radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells and shrink tumors)

Radiation therapy is the use of high-energy x-rays to kill cancer cells and shrink tumors. Radiation for non-Hodgkin's lymphoma usually comes from a machine outside the body (external-beam radiation therapy). Radiation given to the brain is called cranial irradiation. Radiation therapy may be used alone or in addition to chemotherapy.

Additionally, clinical trials are testing the effect of giving drugs to kill the AIDS virus (antiviral therapy) in addition to treatment of lymphoma.

Treatment of AIDS-related lymphomas depends on the stage, histology, and grade of the disease, as well as the general health of the patient. A doctor must consider white blood cell count and any other diseases caused by AIDS that the patient had or currently has.

Standard treatment may be considered based on its effectiveness in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy, and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. To learn more about clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615 or the AIDS Clinical Trials Information Service at 1-800-342-AIDS (1-800-342-2437).

AIDS-RELATED PERIPHERAL/SYSTEMIC LYMPHOMA

Treatment may be one of the following:

1. Standard-dose systemic chemotherapy plus intrathecal chemotherapy.

2. Low-dose systemic chemotherapy plus intrathecal chemotherapy.

3. A clinical trial of new types of chemotherapy or new ways of giving chemotherapy.

AIDS-RELATED PRIMARY CNS LYMPHOMA

Treatment will probably be cranial radiation therapy. A clinical trial of new types of treatment may also be an option.