Fact Sheet Number 509
(NHL)
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PrintLymphoma refers to cancers of white blood cells. Cells called
B-lymphocytes multiply rapidly and form tumors. 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.
The longer you live with a suppressed immune system, the higher
the risk of NHL. NHL can occur even with a high CD4 count. It
can be serious and fatal, sometimes within a year.
Combination antiviral therapy sharply cut the rates of most
opportunistic infections. At first, this was not true for NHL.
Newer studies do show a decrease in NHL, especially CNS lymphoma.
NHL tumors usually occur in the abdomen, bone, brain or other
places. 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 using imaging techniques or biopsies.
The imaging techniques include various scans (CAT, PET, gallium
and thallium.) A biopsy is an examination of cells from a suspected
tumor. In a biopsy, a thin needle is used to get a tiny piece
of the suspected tumor.
NHL is described by grade, stage, and classification:
- The grade means how fast the tumor 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 in several places in the body.
- The classification is based on the cells found in
the tumor. Small-cell (or 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.
Several factors increase the risk of NHL:
- Infection with Epstein-Barr virus.
- Long-term, untreated HIV infection.
- Genetic factors
At the present time we don’t know how to prevent NHL.
Most cancers are treated by a combination of drugs (chemotherapy).
Several types of chemotherapy are used for NHL. Chemotherapy is
known by the initials of the drugs. For example, “CHOP”
is a combination of
- Cyclophosphamide,
- Hydroxydaunomycin,
- Oncovin, and
- Prednisone.
Chemotherapy can clear up tumors in almost 50% of patients.
However, tumors return in almost 25% of patients within about
7 months.
Chemotherapy is very toxic. It suppresses the immune system.
It can cause nausea, vomiting, fatigue, diarrhea, swollen and
sensitive gums, mouth sores, hair loss, and numbness or tingling
in the feet or hands.
Chemotherapy also damages bone marrow. This can cause anemia
(low red blood cells) and neutropenia (low white blood cells).
Neutropenia increases the risk of bacterial infections. More drugs
are sometimes prescribed to fight these side effects.
Central nervous system (CNS) lymphoma is very difficult to
treat. Radiation therapy is often used instead of, or in addition
to chemotherapy. With the use of combination antiviral therapy,
the rate of CNS lymphoma ha dropped sharply.
Researchers are now tudying “monoclonal antibodies.”
These drugs are produced through genetic engineering. They attack
the B cells that are multiplying out of control. The names of
monoclonal antibodies end in “-mab,” such as rituximab.
They work well to shrink tumors and to incrase the time before
tumors return.
Another promising treatment is chemotherapy based on the drug
idarubicin. In an initial study, it worked well for people with
fairly strong immune systems.
NHL, a cancer involving B-cells, affects people with advanced
AIDS. It is a serious and often fatal disease. The use of combination
antiviral therapy has reduced the number of new cases. This is
especially true for central nervous system (CNS) lymphoma.
NHL is treated with chemotherapy drugs. For CNS lymphoma, radiation
therapy is also used. Even if NHL tumors are cleared up, they
tend 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.
New genetically engineered drugs called monoclonal antibodies
are being studied against NHL, as well as new combinations of
chemotherapy.
Revised December 20, 2001
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