Non-Hodgkin’s lymphoma (NHL)

Non-Hodgkin’s lymphoma (NHL) is a form of malignant lymphoma (malignant tumours of the lymph nodes). This term encompasses a large number of different diseases – from aggressive to less malignant or indolent (slowly progressing, non-acute) forms. Malignant lymphomas are relatively rare: In Germany, approx. 5,850 men and 6,250 women contract one of the various form of non-Hodgkin’s lymphoma every year.

Despite intensive research, the causes of lymphoma are still unknown. There are also no specific symptoms, so most lymphomas are only discovered only by chance e.g. during a routine examination.

Possible symptoms
Signs of lymphoma include prolonged swelling of the lymph nodes, weakness, fatigue, and loss of appetite. Tenderness, swelling, and increased susceptibility to infection may also be signs of the disease as well as frequent or persistent fever over 38°C, night sweats, and unexplained weight loss of more than ten percent of the body weight in six months.

Diagnosis of lymphoma
If lymphoma is suspected, patients should be thoroughly examined. This is necessary in order to confirm the diagnosis as well as to determine which form of the disease is present and exactly how far it has spread.

Diagnosis of non-Hodgkin’s lymphoma
Most tests can be performed on an outpatient basis in the speciality department of a hospital or in a specialist practice. An inpatient admission to a hospital is only necessary if the patient’s condition has rapidly deteriorated or if a faster initiation of treatment is necessary.

Medical history and physical examination
The medical history provides information on the speed at which lymph node enlargement and discomfort has developed. During the physical examinations, particular attention will be paid to lymph nodes and lymphatic tissue in the nose and throat; scans are usually also prepared.

Blood tests
For the blood test, a small amount of blood is taken from the arm vein. In malignant lymphomas, there is a shift in the ratio of red and white blood cells and platelets; in some types of lymphoma, lymphoma cells are also found in the blood.

Examination of lymph nodes
To detect cancer cells, a lymph node is removed and examined in highly specialised laboratories. The removal and examination of bone marrow samples from the pelvis (iliac crest puncture) is part of the research programme. If lymphoma is suspected, tissues samples are also taken from an internal organ.

Lumbar puncture
If the central nervous system has been attacked by lymphoma cells, this can be detected in a sample of cerebrospinal fluid (CSF) that is taken using a lumbar puncture (i.e. CSF is removed from the spinal canal under local anaesthesia). If the central nervous system affected – which may be the case in a particularly aggressive lymphoma – a special therapy is initiated.

Assessment of the severity of the disease
Once the type of lymphoma has been established, the physician requires further diagnostics in order to assess the extent of disease.

Imaging methods
Ultrasound, computed tomography or magnetic resonance imaging provide images that accurately show the involvement of the lymph and provide the physician with important information for “staging” i.e. assessing the extent of disease.

If patients have lymphoma lesions in the skeleton, a bone scan with low-level radioactive substances is performed.

Staging and classification
The results of the investigations are generally received after a few days and form the basis of the individual treatment plan. Physicians and lymphoma specialists work with an internationally accepted classification that describes the spread of the disease in a clear and comprehensible manner.

Chronic lymphocytic leukaemia (CLL)

The word “leukaemia” means “white blood” and refers to the abnormally increased number of white blood cells in the blood of those affected. The mean age for CLL is 65 years; men are affected approx. two to three times more frequently than women are. Because CLL progresses slowly and initially causes little discomfort, it is often only discovered by chance. Patients usually live with the disease for several years without being substantially limited in everyday life.

Chronic lymphocytic leukaemia (CLL) is a chronic form of the disease in which the lymphocytes degenerate. CLL is therefore not classified as a form of leukaemia but rather as a form of lymphoma (non-Hodgkin’s lymphoma).

The disease remains unnoticed for a long time
Possible symptoms of CLL include prolonged swelling of lymph nodes, enlarged spleen and liver, weakness, fatigue, and loss of appetite. Anaemia, pallor, dizziness, increased susceptibility to infection, unexplained fever, and skin lesions may also be symptoms of the disease.

Quality of life can be ensured
For some patients, the life expectancy is not limited (resting CLL). In such patients, a “watch and wait” approach is taken. Only when the disease leads to a significant reduction in performance, symptoms arise, or the blood count significantly deteriorates is therapy initiated.

Treatment of CLL
In the case of CLL, the most important goal of therapy is prolonging the life expectancy of patients while maintaining the quality of life. Decisions regarding treatment are therefore made according to the severity of the disease and the wishes of the patient. Depending on the severity, either chemotherapy (with pills or infusions), antibodies against the lymphoma cells, or combinations of chemotherapy (or high-dose chemotherapy) and stem cell/bone marrow transplants are used.

Concomitant treatment is important
A good adjunct treatment is important for improving the quality of life of those affected and minimising side effects. Most symptoms can be alleviated by medications, and many patients do not experience side effects or late effects after treatment.

Possible late effects of treatment are:

  • Fatigue and exhaustion
  • Breakdown of muscle mass as a result of rest and minimal exercise
  • Susceptibility to infection
  • Reduced fertility

Multiple Myeloma

Multiple myeloma or plasmacytoma is a common blood cancer. Because of an impaired function of the B-lymphocytes, “myeloma proteins” are formed instead of functional antibodies. Large quantities of these proteins can be detected in the blood and urine.

In multiple myeloma, the bone mass is also affected. Unlike other non-Hodgkin’s lymphoma, lymphoma cells can also be found in the skeleton. This can cause osteoporosis-related diseases with associated bone pain and fractures. The myeloma proteins can occasionally affect kidney function, thereby resulting in frequent urinary tract infections.

Different therapies for each stage
In the early stage, a “watch and wait” approach (i.e. expectant monitoring of disease development) is taken. So far, there has been no evidence that symptom-free patients can benefit from early treatment or that the course of the disease can be improved by early treatment.
In the case of progressive disease or kidney problems caused by hyper-coagulation (thickening) of the blood, chemotherapy is performed. In the later stages, high-dose chemotherapy is usually combined with a stem cell transplant, whereby the patient’s own stem cells are used (autologous transplantation). As an alternative to high-dose chemotherapy or stem cell transplantation, a combination of cytostatic agents and cortisone are given in tablet form.

Not all myeloma patients respond equally well to treatment. In the long term, most patients can expect a relapse, even if the first treatment was successful or the patient was responsive to the medication.

Concomitant treatment
Supportive care measures are particularly important for patients with multiple myeloma. In addition to an individualised pain treatment with analgesics, radiotherapy and medication are administered in order to inhibit bone resorption. Susceptibility to infection and anaemia are also treated.

Lymphomatous meningitis

Lymphomatous meningitis is a life-threatening complication of lymphoma in which the cancer cells penetrate the meninges via the spinal fluid.

Lymphomatous meningitis is a relatively rare disease. It is diagnosed in approx. 7–15% of patients with malignant lymphoma – usually only in the late course of the disease. Lymphomatous meningitis occurs in approx. 10,000 patients worldwide.

Fast medication required
Lymphomatous meningitis often occurs without initial symptoms and is therefore often discovered late with the sudden occurrence of nausea, vomiting, headaches, neck pain, back pain, paralysis, or even seizures. Starting treatment quickly relieves the patient and improves the prognosis for the remaining lifetime.

Making treatment as comfortable as possible
In order to reach the affected regions of the brain, the active agent must be injected into the spinal fluid. There are new medications that enable administration over two-week cycles.

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