(March 18, 2009 - Insidermedicine)
At the American Society of Hematology meeting in San Francisco, we spoke with Dr. Jonathan Friedberg, who is Associate Professor and Chief, Department of Medicine at the University of Rochester School of Medicine. Dr. Friedberg is also Associate Professor at the James P. Wilmot Cancer Center.
What is Non-Hodgkins lymphoma?
Dr. Friedberg: I think the important distinction is that Non-Hodgkins lymphoma (NHL) is actually about 30 or 40 different diseases. It's critical not only to say you have lymphoma, but to understand exactly what kind of lymphoma you have. There are some lymphomas that grow so slowly that we don't even need to treat, and there are others that grow so quickly that we emergently admit patients to the hospital. So the important first step is to make sure you have an accurate diagnosis of the subtype of lymphoma and that often requires an expert center or hematopathologist to review the slides.
What does the evaluation consist of?
Dr. Friedberg: Usually, once you establish a diagnosis of a subtype of lymphoma, the next step is to determine whether there are symptoms present and where the lymphoma is in the body. Questions regarding symptoms often involve things like fever, chills, weight loss, night sweats, and skin rash. As far as staging--or where the lymphoma is in the body--general things may include some routine blood testing, CT scans (which are x rays of the chest, abdomen and pelvis), sometimes a PET scan (which is a fancy scan that can make lymphomas glow), and often a bone marrow biopsy.
Is a bone marrow biopsy the positive test?
Dr. Friedberg: Bone marrow biopsy is done because on our imaging studies we cannot see the bone marrow very well. Lymphomas are blood cell problems. Turns out, all blood cells--the malignant blood cells as well as normal blood cells--are made in the bone marrow. So it's important to assess the bone marrow.
What are the therapeutic options for NHL?
Dr. Friedberg: It differs dramatically depending on what subtype of lymphoma a patient has. There are a group of indolent ,or slow growing, lymphomas where, these lymphomas are generally not curable diseases but are very treatable diseases. And options in those patients might include: a period of observation off of therapy, single agent antibody treatments, combinations of chemotherapy and antibody treatments, occasionally, radiation therapy and new agents. The more aggressive lymphomas are curable diseases and there, the standards are generally combinations of chemotherapy and antibody treatments which can lead to cures in more than half of patients.
Is genetic testing important?
Dr. Friedberg: So in general it is not felt that NHL is inherited. But there are two types of genetic testing; one is to test whether you have the risk of the disease that you've inherited. But it turns out that what is important is to look sometimes at the DNA within the lymphoma. What lymphoma is is a blood cell with a mistake in it. And we can identify many of these mistakes by doing genetic analysis of the lymphomas.
If I had an enlarged, painless lymph node in my neck and was diagnosed with NHL...
Dr. Friedberg: So if I had an enlarged painless lymph node that was in my neck, the first thing I would do is get a good biopsy of that lymph node--have it reviewed by an expert hematopathologist to establish not only a diagnosis of lymphoma, but the subtype of lymphoma. I would then go to an oncologist and expect staging and a full history and physical exam that would determine what the treatment plan would be. And I would hope that this would be in a center of excellence, so that I'd have access to all of the new therapies available.