| AIDS-Related Non-Hodgkins
Lymphoma (NHL)
What is Non-Hodgkins Lymphoma (NHL)?
NHL is the most common of all lymphomas that affects people with
HIV. Lymphomas are cancerous tumors of the lymphatic system. The
lymphatic system is a part of the immune system that defends the
body against disease. NHL occurs when the body's B-cells or T-cells
(types of white blood cells) start growing and dividing abnormally
causing tumors to develop.
NHL is separated into two major categories: systemic lymphomas
and primary central nervous system (CNS) lymphomas. Systemic lymphomas
occur mostly in people with CD4 counts over 50. CNS lymphomas occur
mostly in people with CD4 counts 50 and under and who have had other
opportunistic infections.
In people with HIV, NHL often develops outside the lymph nodes,
including the liver, bone marrow, stomach, brain, mouth and anus.
What are the Signs and Symptoms of NHL?
Swollen lymph nodes are the most common sign of NHL. Other symptoms
include fevers, weight loss, fatigue, rectal pain, abnormal pain
or vomiting. People with CNS lymphoma can develop confusion, loss
of memory or speech, changes in personality, seizures, headaches
or partial paralysis. Some of these symptoms could be caused by
other HIV-related conditions. However, if these symptoms last for
more than a week, see a doctor immediately because NHL can grow
very rapidly.
How is NHL Diagnosed?
A doctor will need to perform many different tests to tell if your
symptoms are caused by NHL. A biopsy is required to confirm that
you have NHL. A biopsy is when a small piece of your tissue is surgically
removed from the suspected area. Different types of x-rays are also
needed to find out what areas are affected and will help determine
your treatment options. These tests may include evaluation of the
brain, chest and abdomen with CT (computed tomography scan) or MRI
(magnetic resonance imaging). You might also have to undergo a gallium
scan. This involves an injection of a radioactive dye into the body.
Then on the following day, you must lie under a sensor for approximately
an hour. To rule out CNS lymphoma, a bone marrow biopsy and a lumbar
puncture (spinal tap) will be needed.
Can NHL Be Treated?
About half of the people with NHL can be treated successfully with
combinations of chemotherapy drugs. About half of these people will
develop NHL again within two years. Your doctor will prescribe treatments
depending on the type of NHL you have, what your T-cells are and
whether or not you have had other opportunistic infections in the
past.
Many of these powerful drugs are difficult for people to tolerate
when they have a weakened immune system. If you have a very weak
immune system, you might be given half the regular dose that is
given to HIV-negative people with NHL. This has been proven to be
safer and equally as effective.
While receiving chemotherapy and radiation for NHL, other medications
might be required to treat or prevent some common side effects of
treatment such as suppression of white blood cells. G-CSF (granulocyte
colony stimulating factor) has been proven to boost a low white
count and decrease the risk of bacterial infections. In addition,
you will often be given other drugs to prevent you from getting
PCP (pneumocystis carinii pneumonia), MAC (mycobacterium avium complex),
herpes, fungal infections and to prevent lymphoma from developing
in the lining of the brain and spinal fluid.
People with CNS lymphoma usually receive total brain radiation
therapy along with regular chemotherapy. Recent studies have shown
that radiation therapy improves the quality of life in 75 percent
of people with CNS lymphoma even though it does not necessarily
affect length of survival.
What are Some Side Effects of Chemotherapy?
Common side effects of chemotherapy include nausea (which can be
severe), vomiting, diarrhea, swollen/sensitive gums, mouth sores,
loss of appetite, hair loss and peripheral neuropathy (numbness
or tingling sensation in the hands or feet). Your doctor may prescribe
medication to help ease the discomfort of these side effects.
Standard Chemotherapy Combinations Used to Treat People with NHL:
CHOP: C = Cyclophosphamide; H = Adriamycin; O = Vincristine (Oncovin);
and P = Prednisone (a steroid)
M-BACOD: M = Methotrexate; B = Bleomycin; A = Adriamycin; C =
Cyclophosphamide; O = Vincristine; and D = Dexamethasone (a steroid)
Ask Your Doctor About the Following Experimental Treatments for
NHL:
CDE (continuous infusion chemotherapy given in combination with
ddI)
MSBG (Methylglyoxal-bis-guanylhydrazone)
Topotecan
Anti-B4-blocked Ricin
Anti-EBV strategies (anti- EBV cytotoxic T lymphocytes and 5-Azacytidine
[5-AC])
For more information about clinical studies for AIDS-Related Non-Hodgkins
Lymphoma call the AIDS Clinical Trials Information Service at 1-800-874-2572.
© 2003 Gay Men's Health Crisis |
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