Hair loss Treatment Center

PARTICIPANTS John D. Hainsworth, MD Sarah Cannon Cancer Center

Joining me to discuss the ins and outs of NHL and its treatment is Dr. John Hainsworth of the Sarah Cannon Cancer Center here in Nashville. Dr. Hainsworth, thank you for joining us.

What is NHL and how does non-Hodgkin's lymphoma differ from Hodgkin's lymphoma?

JOHN D. HAINSWORTH, MD: NHL -- or non-Hodgkin's lymphoma -- is actually not one disease, but a family of diseases that are all types of lymphomas. Hodgkin's lymphoma -- or Hodgkin's disease -- is also a type of lymphoma, and actually that was one of the first ones described. It was then found that, actually, there are different ones that originate from different lymphocytes, have different ways that they act clinically, so all the ones that -- except for Hodgkin's disease are lumped into this category of non-Hodgkin's lymphoma.

MARYANN BIRD: What are the most common subtypes of NHL?

JOHN D. HAINSWORTH, MD: There are two types that are probably the most common -- and these two types are very different in the way they act. One is a group of lymphomas called the "follicular" lymphomas. They are generally low-grade lymphomas, and then another type called "large-cell" lymphomas. They look different under the microscope, they act different, and the large-cell lymphomas are very aggressive. So without treatment, patients would do very poorly with those, and actually those are fatal within a number of months in most patients.

MARYANN BIRD: What is the difference between lymphomas and leukemias?

JOHN D. HAINSWORTH, MD: In general, leukemias involve mostly the blood and the bone marrow. Lymphomas are much more likely to involve lymph nodes, other organs, and sometimes also the bone marrow.

MARYANN BIRD: Are there specific risk factors?

JOHN D. HAINSWORTH, MD: The risk factors for lymphomas are a number of other diseases that affect the immune system. Patients who have immune suppression because they have transplants, autoimmune diseases likes rheumatoid arthritis, lupus -- HIV infection has been a common one recently that's lead to a rise in lymphoma incidence.

MARYANN BIRD: What are the signs and symptoms of NHL? Do they differ from the symptoms of other blood cancers?

JOHN D. HAINSWORTH, MD: I think this is a hard question to answer, because of the different kinds of lymphoma, so there's a wide variation.

In general, for the low-grade lymphomas, usually just finding some lymph nodes enlarged. Other symptoms are very much more common, though, in patients who have aggressive lymphomas and they usually feel bad. They often have fatigue, weight loss, fevers, night sweats, a variety of other things. And then local symptoms depending on where the lymphoma's involving.

MARYANN BIRD: How is NHL diagnosed?

JOHN D. HAINSWORTH, MD: The actual diagnosis is based on a biopsy of some kind. This is actually one of the diseases that most challenging for pathologists. It's fairly easy to say, "This is a lymphoma." But sometimes it's not so easy to put it into a category. That's a very important for treatment.

MARYANN BIRD: And that leads me to the next question. Can NHL be cured?

JOHN D. HAINSWORTH, MD: And again, that's -- it's different diseases, so some of them -- the answer to that question is yes. In fact, some of the subtypes of aggressive lymphoma and large-cell lymphoma, the cure rate's pretty high. Others the answer is no. Follicular lymphomas traditionally cannot be cured, although often patients do well with them for a long time.

MARYANN BIRD: Briefly, what are the treatment options for NHL?

JOHN D. HAINSWORTH, MD: Let's divide that question into two parts. With the -- let's talk about treatment options for the ones that are curable, and those are usually the higher-grade ones, which is sort of paradoxical. These are the ones that, without treatment, the patients die in a few months. But, with appropriate treatment, these are the ones that are curable.

So these traditionally have been treated with a combination, a fairly intensive combination of drugs, of chemotherapy drugs. Several drugs given at the same time, usually for a period of four to six months.

On the other side, the patients that have low-grade lymphomas -- usually treatments are not like that. Usually, there was one or two drugs that are designed to be easier to tolerate. Sometimes the treatments aren't given right away, and those patients can live for a long time -- some of them. But still they live with the lymphoma rather than actually getting rid of it.

And looking ahead into the future, I think we're all really excited in this area, that there are new ways coming ahead of treating lymphomas. And these targeted treatments that look for specific differences between the lymphocytes and lymphomas versus other cells and therefore can treat the lymphoma without causing a lot of the side effects that we associate with cancer treatment.

Rituxan is the first drug on the market that is used widely in b-cell lymphomas, and it's been an extraordinarily good new drug. I think it surprised all of us as to how good the drug is.

There are a number of other antibodies that are coming along before the aggressive lymphomas -- it's already been shown that if you add rituxan to the standard combination chemotherapy, you can cure more patients. So that's the first time that's happened in a long time. In the low-grade lymphomas, these provide another treatment option of minimal toxicity to patients and often can be used for several years without giving patients chemotherapy at all.

MARYANN BIRD: How do the side effects of these new targeted therapies compare with traditional chemotherapy?

JOHN D. HAINSWORTH, MD: The targeted drugs -- they're not all going to be the same. Rituxan is a drug that's out there right now, and we have a large experience with it during the last several years. This drug has none of the chemotherapy toxicity. No hair loss. No nausea and vomiting. No lowering of the blood counts. What it does have are some reactions during the infusion.

The other thing that's nice about rituxan is it's given once a week for four weeks. And that's it. The course of treatment's over. Whereas -- as you probably know -- the course of chemotherapy treatments have been about six months. What happens when you add rituxan to the chemotherapy, you get the side effects of the chemotherapy plus a few reactions while you get the rituxan. So, it's basically been easy to add.

Some of the other targeted therapies seems like they're going to be a little more toxic. And part of that depends on what's the target. How are they given and how they actually work to kill the cancer cells.

MARYANN BIRD: So let me understand this. Traditional chemotherapies attack all the cells in the body, and these targeted therapies only attack specific cells, and therefore the reaction's not so violent.

JOHN D. HAINSWORTH, MD: That's generally correct, although there are reasons why the chemotherapy drugs work against cancer cells better than they, say, would work against your normal cells. They work against cells that are rapidly dividing, and most cancer cells are dividing much more frequently than, say, cells in your lungs or in your heart or in normal organs.

MARYANN BIRD: Dr. Hainsworth, thank you for joining us.

JOHN D. HAINSWORTH, MD: Well, you're welcome, it's my pleasure.

MARYANN BIRD: And thank you for joining our webcast. I'm Maryann Bird.