Fact Sheet Number 508
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PrintLymphoma refers to cancers that involve a type of white blood
cell. Cells called B-lymphocytes multiply rapidly and form tumors.
These can occur in the lymph nodes, bone marrow, intestines,
or spinal cord. Lymphoma of the brain or spinal cord is called
central nervous system (CNS) lymphoma.
AIDS-related lymphoma is sometimes called Non-Hodgkin’s Lymphoma
(NHL). (Hodgkin’s Disease, another type of lymphoma, is rare
in people with HIV.) In 1985, the Centers for Disease Control
added NHL to the list of diseases that define AIDS in people with
HIV infection.
The longer you live with a suppressed immune system, the more
likely you are to develop NHL. It is serious and fatal, often
within a year. NHL is usually associated with long-term HIV disease
and low CD4 counts.
Combination antiviral therapy has significantly reduced the
rates of most opportunistic infections. This is not true for
NHL.
The first signs of NHL are swollen lymph nodes, fever, night
sweats, and weight loss of more than 10%. These symptoms occur
with several AIDS-related illnesses. If doctors cannot find another
cause for these symptoms, they will test for NHL.
NHL is usually diagnosed based on imaging techniques or biopsies.
The imaging techniques can include various scans (CAT, PET, gallium
and thallium.) Biopsies involve microscopic examination of cells
from lymph nodes or other affected tissues.
A case of NHL is described by grade, stage, and classification:
- The grade is based on how fast the cancerous cells
are growing.
- The stage indicates how much the cancer has spread.
Stage I means limited involvement in one place. Stage IV means
major involvement at multiple sites.
- The classification is based on the cells found in
the tumor. Small-cell lymphoma (Burkitt’s lymphoma) and large-cell
“immunoblastic” lymphomas grow quickly. Large-cell
“diffuse” lymphomas are somewhat less dangerous.
NHL is caused by long-term stimulation of the immune system.
When B-cells multiply at a high rate for many years, more mutations
occur. Some of these mutations cause cancer.
Infection with Epstein-Barr virus contributes to NHL. So does
long-term HIV infection. Recent studies show that genetic factors
are linked to a higher risk of NHL.
There is no known way to prevent NHL.
Most cancers are treated by a combination of drugs (chemotherapy).
There are several treatments for NHL. They are known by the
initials of the drugs. For example, “CHOP” is a combination
of Cyclophosphamide, Hydroxydaunomycin, Oncovin,
and Prednisone.
Chemotherapy can clear up NHL in almost 50% of patients. But
almost 25% of patients whose NHL cleared up will get it again
within about 7 months.
Chemotherapy is very toxic, and suppresses the immune system.
Common side effects include nausea, vomiting, fatigue, diarrhea,
swollen and sensitive gums, mouth sores, hair loss, and numbness
or tingling in the feet or hands.
Chemotherapy can also damage bone marrow. This can cause anemia
(low red blood cells) and neutropenia (low white blood cells).
Neutropenia can increase the risk of bacterial infections. More
drugs are sometimes prescribed to fight these side effects.
- Ondansetron (Zofran) can control nausea and vomiting.
- Erythropoietin (Epogen or Procrit) increases the number of
red blood cells.
- Granulocyte-colony-stimulating factor (G-CSF, Neupogen) increases
production of neutrophils. This is a treatment for neutropenia.
Central nervous system (CNS) lymphoma is very difficult to
treat. Radiation therapy is often used instead of, or in addition
to chemotherapy. In some individuals, antiviral therapy seems
to help treat NHL.
More recently, researchers have gotten good results by using less
toxic, lower doses of chemotherapy.
When other treatments have failed, NHL sometimes responds to
daunorubicin. This drug has been approved for use against Kaposi’s Sarcoma (KS). New combinations
of chemotherapy are also being studied.
NHL, a cancer involving B-cells, affects people with advanced
AIDS. It is a serious and fatal disease. New combinations of
antiviral drugs have not reduced the number of new cases.
NHL is treated with chemotherapy drugs. If the disease is
in the central nervous system, radiation therapy is also used.
Even if NHL is cleared up, it tends to return in many people.
Treatment of NHL is difficult. People who get it have very
weak immune systems. Additional drugs are often needed to deal
with the side effects of chemotherapy.
Several new, different combinations of chemotherapy are being
studied. Daunorubicin, approved to treat KS, works in some cases
where other treatments have failed.
Revised December 11, 2000
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