Non-Hodgkin's
lymphoma (NHL) is cancer of the cells of the
lymphatic system. In non-Hodgkin's lymphoma, cells in
the lymphatic system either divide and grow without order or control, or old
cells do not die as cells normally do. Non-Hodgkin's lymphoma can start almost
anywhere in the body. It may occur in a single lymph node, a group of lymph
nodes, or an organ such as the spleen. Non-Hodgkin's lymphoma can spread to
almost any part of the body, including the liver, bone marrow, and
spleen.
Over time, lymphoma cells may replace the normal cells in
the bone marrow. Bone marrow failure results in the inability to produce red
blood cells that carry oxygen, white blood cells that fight infection, and
platelets that stop bleeding.
Non-Hodgkin's lymphoma is different
from
Hodgkin's lymphoma and occurs about 8 times more
often.
Are there different types of non-Hodgkin's lymphoma?
There are many different types of non-Hodgkin's lymphoma. Over the years,
experts have used a variety of terms to classify these different types. Most
often, they are grouped by how the cancer cells look under a microscope and how
quickly they are likely to grow and spread. Aggressive lymphomas, also known as
intermediate- and high-grade lymphomas, tend to grow and spread quickly and
cause severe symptoms. Nonaggressive lymphomas, also called indolent or
low-grade lymphomas, tend to grow quite slowly and cause fewer symptoms early
in the disease course.
In an effort to increase the understanding
of lymphoma and standardize treatment, experts in Europe and North America have
revised the classification of lymphoma (Revised European-American Lymphoma
Classification [REAL], published by the World Health Organization
[WHO]).
What causes non-Hodgkin's lymphoma?
The cause of
non-Hodgkin's lymphoma is not known. The incidence of NHL has continued to
increase over the years. When a person has non-Hodgkin's lymphoma, abnormal
rapid cell growth occurs. This abnormal growth may be triggered by an infection
or exposure to something in the environment. Non-Hodgkin's lymphoma is not
contagious.
Non-Hodgkin's lymphoma is more common in men
than in women.
The likelihood of getting non-Hodgkin's lymphoma
increases as you get older.
Non-Hodgkin's lymphoma is most common
among those who have an inherited immune deficiency, an
autoimmune disease, or
HIV. It also occurs among those who take medicines
that
impair the immune system following an organ
transplant.
Viral infections, such as with human T-lymphotropic
virus type I (HTLV-1),
hepatitis C, and
Epstein-Barr virus, increases the risk of developing
non-Hodgkin's lymphoma.
Exposure to pesticides, solvents, or
fertilizers increases the risk of developing non-Hodgkin's lymphoma.
What are the symptoms?
The most common symptom of
non-Hodgkin's lymphoma is a painless swelling of the
lymph nodes in the neck, underarm, or groin. Other
symptoms may include:
Unexplained fever.
Night
sweats.
Extreme fatigue.
Unexplained weight
loss.
Itchy skin.
Reddened patches on the skin.
Cough or shortness of breath.
Pain in the abdomen
or back.
How is non-Hodgkin's lymphoma diagnosed?
When
non-Hodgkin's lymphoma is suspected, a piece of tissue (biopsy) is needed to confirm the diagnosis. This can
sometimes be done by inserting a needle into a
lymph node, but usually the entire lymph node must be
removed. The piece of tissue is then analyzed under a microscope by a
pathologist to see whether NHL is present.
How is it treated?
Treatment of non-Hodgkin's
lymphoma depends on the type of lymphoma, the stage of the disease, and your
age and general health. The treatment options are:
The cause of
non-Hodgkin's lymphoma (NHL) is unknown. The incidence
of NHL has continued to increase over the years. When a person has
non-Hodgkin's lymphoma, abnormal rapid cell growth occurs. This abnormal growth
may need a "trigger" to start, such as an infection or exposure to something in
your environment. NHL is not contagious and is not caused by injury.1
Symptoms
Symptoms of
non-Hodgkin's lymphoma (NHL) depend on the area of the
body affected by the disease. The most common symptom is a painless swelling of
the
lymph nodes in the neck, underarm, or groin. Other
symptoms may include:
Unexplained fever.
Night sweats.
Extreme
fatigue.
Unexplained weight loss.
Itchy
skin.
Reddened patches on the skin.
Cough or shortness of breath.
Pain in the abdomen or
back.
What Happens
In
non-Hodgkin's lymphoma (NHL), either abnormal cells in
the
lymphatic system divide and grow without order or
control or old cells do not die normally. Lymphatic tissue is present in many
areas of the body, so non-Hodgkin's lymphoma can start almost anywhere in the
body.
Non-Hodgkin's lymphoma may occur in a single
lymph node, a group of lymph nodes, or an organ. And
it can spread to almost any part of the body, including the
liver,
bone marrow, and
spleen. Doctors classify NHL into
stages based on where the lymphoma is growing in the
body.
Over time, lymphoma cells may replace the normal cells in
the bone marrow. Bone marrow failure results in the inability to produce red
blood cells that carry oxygen, white blood cells that fight infection, and
platelets that stop bleeding.
Long-term survival depends on the
type of non-Hodgkin's lymphoma and the stage of the disease when it is
diagnosed. Approximately 81 out of 100 people diagnosed with non-Hodgkin's
lymphoma are alive 1 year after the disease is diagnosed. That number drops to
about 63 out of 100 at 5 years and 49 out of 100 at 10 years.2
What Increases Your Risk
No one knows exactly what
increases your risk of getting
non-Hodgkin's lymphoma (NHL). Experts do agree that
the disease is not caused by injury and is not contagious. The following risk
factors may increase your chances of having the disease. But most people with
these risk factors do not ever have non-Hodgkin's lymphoma, and many people who
have non-Hodgkin's lymphoma do not have any of these risk factors.1
Being male. NHL is more common in men than
in women.
Age. The likelihood of getting NHL
increases as you get older.
Impaired immune system. NHL is most common among those who have an
impaired immune system, an autoimmune disease, or HIV
or AIDS. It also occurs among those who take immunosuppressant medicines, such
as medicines following an organ transplant.
Bacterial infection. Infection with
Helicobacter pyloriincreases the risk of lymphoma
involving the stomach.
Environmental exposure. Exposure to agricultural pesticides or fertilizers, solvents
and other chemicals, rubber processing, asbestos, and arsenic increases the
risk of developing NHL.
When To Call a Doctor
Call your doctor to schedule an
appointment if you have had any symptoms for longer than 2 weeks, such
as:
Painless swelling in the lymph nodes in the
neck, underarm, or groin.
Unexplained fever.
Drenching
night sweats.
Extreme fatigue.
Unexplained weight loss
in the past 6 months.
Itchy skin.
Cough or shortness
of breath.
Pain in the abdomen or back.
Watchful Waiting
Watchful waiting (surveillance) is a period
after the diagnosis of some types of non-Hodgkin's lymphoma (NHL) when little
or no treatment is used. Watchful waiting is not appropriate for aggressive or
high-grade lymphoma. Watchful waiting does not mean that your doctor is giving
up or refusing to give you treatment. During this time you will:
Have regularly scheduled appointments with your
doctor.
Receive periodic medical tests, including scans and blood
tests.
Be told which symptoms to report to your doctor
immediately.
Watchful waiting is often as effective as immediate
aggressive treatment for some types of NHL. People with advanced low-grade,
indolent lymphomas often live a long time without symptoms.3, 4
Watchful waiting ends
when one of the following occurs:
Symptoms develop.
Lymphoma tumor
size is larger than
2 in. (5.1 cm) and
growing.
When NHL is suspected, a tissue sample (biopsy) is needed to make a diagnosis. A biopsy for
non-Hodgkin's lymphoma is usually taken from a lymph node, but other tissues
may be sampled as well. A
surgeon will remove a sample of tissue so that a
pathologist can examine it under a microscope to check
for cancer cells.
If
non-Hodgkin's lymphoma (NHL) is suspected, your doctor
will ask about your medical history and perform a physical examination. This
exam includes checking for enlarged
lymph nodes in your neck, underarm, and groin.
A tissue sample (biopsy) is needed to make a diagnosis.
A biopsy for non-Hodgkin's lymphoma is usually taken from a
lymph node, but other tissues may be sampled as
well.
Your doctor
may also order other tests, including:
Blood tests, such as a
chemistry screen to measure the levels of several
substances in the blood and a
CBC (complete blood count) to provide information
about the kinds and numbers of cells in the blood.
A
chest X-ray to provide a picture of organs and
structures within the chest, including the heart and lungs, the blood vessels
of the chest, and the thin sheet of muscle (diaphragm) that separates the chest
cavity from the abdominal cavity.
A
CT scan (computed tomography) or
MRI (magnetic resonance imaging) to provide detailed
pictures of the organs and structures in the chest, abdomen, and pelvis.
PET scan (positron emission tomography) to show areas
of increased
metabolic activity. Metabolic activity refers to all
of the chemical processes that take place in the body, such as using sugars for
energy. Metabolic activity is generally high in cancer cells.
Flow
cytometry, which checks the types of cells in a biopsy sample. This test helps
your doctor find out the type of lymphoma.
Multigated acquisition
(MUGA) scan, which is a type of
cardiac blood pool scan. A cardiac blood pool scan
shows how well your heart is pumping blood to the rest of your body. A MUGA
scan can show whether your heart is strong enough to tolerate certain types of
chemotherapy, like doxorubicin.
Early Detection
At this time, there are no special tests
recommended for early detection of non-Hodgkin's lymphoma. The best strategy
for early diagnosis is to see your doctor if you develop signs or symptoms of
NHL.
Treatment Overview
Different types of treatment are
used for different types of
non-Hodgkin's lymphoma (NHL). Treatment of NHL depends
on:
The type of lymphoma. The kind of treatment
you have will depend on whether you have B-cell or T-cell lymphoma and whether
it is fast-growing or slow-growing.
The size of the tumor and
whether it is greater than
10 cm (3.9 in.). It also
matters where the lymphoma is located and what organs are
involved.
Your general health.
Whether you have had
lymphoma in the past (recurrent disease). Although lymphoma that has come back
(recurred) may be controlled, it often is not curable.
Initial treatment
Treatment recommendations that
may be appropriate when you are first diagnosed with
non-Hodgkin's lymphoma include:
Watchful waiting (surveillance), a
period of time after the diagnosis of some types of NHL when little or no other
treatment is used. Watchful waiting gives as good or better results than more
aggressive treatment for some types of NHL. Your doctor may discuss watchful
waiting with you if you have an advanced, low-grade (indolent)
lymphoma.3, 4 Watchful waiting
is not appropriate for aggressive lymphoma or less aggressive lymphoma that has
gotten larger or is causing symptoms.
Radiation therapy,
which is often the treatment of choice for early-stage, indolent NHL. Radiation
therapy may be used alone or combined with other treatment options for more
advanced NHL.
Medicines, such as
chemotherapy or
monoclonal antibody therapy, which often cure NHL.
Even when cure is not possible, treatment with medicines may allow you to live
a long time without symptoms.
If you have recently been diagnosed with non-Hodgkin's
lymphoma, you may experience a wide variety of emotions. Most people experience
some denial, anger, and grief. Other people may have fewer emotions. There is
no "normal" or "right" way to react to a diagnosis of lymphoma. There are many
steps you can take to help with your emotional reactions. You may find that
talking with family and friends helps you with your emotions. Some people may
find that spending time alone is what they need.
If your reaction
is interfering with your ability to make decisions about your health, it is
important to talk with your doctor. Your cancer treatment center may offer
psychological or financial services. You may also contact your local chapter of
the American Cancer Society to help you find a support group. Talking with
other people who may have had similar feelings can be very helpful.
You may use
home treatment to help you manage the side effects that may happen with NHL
or its treatment.
Ongoing treatment
Schedule regular follow-up
examinations with your doctor after you have been treated for
non-Hodgkin's lymphoma. Follow-up care is an important
part of the overall treatment plan. During regular follow-up care:
You will probably be seen every 3 to 4 months for the first 2
years and then every 6 months until it has been 5 years since your diagnosis.
After that, you will only need annual checkups if you have had no
relapse.
Changes in health can be discussed with your doctor. To
monitor your health, your doctor may obtain lab tests, such as a
chemistry screen and
CBC, and imaging tests, such as a
chest X-ray or
CT scan.
Report to your doctor any problems you have, as soon as
they appear. If you are having a problem, you may need to make some new
appointments.
Treatment if the condition gets worse
You may be
offered the following treatment options if your disease progresses:
Chemotherapy often effectively treats recurrent NHL.
Sometimes a person may take one type of chemotherapy for several cycles and
later be switched to different medicines if the first medicines are no longer
working.
Stem cell transplant (bone marrow
transplant) is often used to treat recurrent lymphoma. Stem cell transplant may
be offered as part of standard treatment or in a clinical trial. Talk with your
doctor to see if a clinical trial may be available for your type of recurrent
disease.
Survival rates have improved
as a result of
clinical trials. Clinical trials provide evidence
about new medicines and treatments that may help people who have non-Hodgkin's
lymphoma live longer and have a better quality of life. If you are interested
in taking part in a clinical trial, check with your doctor to see if there are
any clinical trials available in your area.
Your doctor may use
the term "remission" instead of "cure" when talking about the effectiveness of
your treatment. Although many people with non-Hodgkin's lymphoma are
successfully treated, the term remission is used because cancer can return. It
is important to discuss the possibility of recurrence with your doctor.
Even after effective treatment for NHL, you may be at slightly higher
risk for other types of cancer, especially melanoma, lung, brain, kidney, and
bladder cancers. Be watchful for any symptoms of cancer.
For more
information about specific treatments, see the following topics:
There is no known way to prevent
non-Hodgkin's lymphoma (NHL). Most people with NHL do
not have known risk factors.
Home Treatment
During treatment for any stage of
non-Hodgkin's lymphoma (NHL), you can use home
treatment to help manage the side effects that may accompany NHL or its
treatment. Home treatment may be all that is needed to manage the following
common problems. If your doctor has given you instructions or medicines to
treat these symptoms, be sure to follow them. In general, healthy habits such
as eating a balanced diet and getting enough sleep and exercise may help
control your symptoms.
Home treatment for nausea or vomiting
includes watching for and treating early signs of dehydration, such as a dry
mouth, sticky saliva, and reduced urine output with dark yellow urine. Your
doctor also may prescribe
medicines to control nausea and vomiting. For more
information on how to deal with these side effects, see:
Home treatment for diarrhea includes
resting your stomach and being alert for signs of dehydration. Check with your
doctor before using any nonprescription medicines for your
diarrhea.
Home treatment for constipation
includes gentle exercise along with adequate intake of fluids and a diet that
is high in fruits, vegetables, and fiber. Check with your doctor before using a
laxative for your constipation.
Home treatment for fatigue includes making sure you get extra rest while you are receiving
chemotherapy or radiation therapy. Let your symptoms be your guide. You may be
able to stick to your usual routine and just get some extra sleep. Fatigue is
often worse at the end of treatment or just after treatment is
completed.
Home treatment for a sore mouth
includes changing your diet, rinsing your mouth with liquid medicines, and
putting a baking soda paste or nonprescription medicine on mouth sores.
Other issues that may arise include:
Hair loss. This can be emotionally
distressing. Not all chemotherapy medicines cause hair loss, and some people
have only mild thinning that is noticeable only to them. Talk to your doctor
about whether hair loss is an expected side effect with the medicines you will
take.
Sleep problems. If you find you have trouble sleeping,
having a regular bedtime, getting some exercise during the day, avoiding naps,
and using other tips to relieve sleep problems may help you sleep more easily.
Many people with lymphoma face emotional issues because of
their disease or its treatment.
The diagnosis of any type of cancer and the
need for treatment can be very stressful. You may be able to
reduce your stress by expressing your feelings to
others. Learning relaxation techniques may also help you reduce your
stress.
Your feelings about your body may change following a
diagnosis of cancer and the need for treatment. Adapting to your body image
changes may involve talking openly about your concerns with your partner and
discussing your feelings with your doctor. Your doctor may also be able to
refer you to organizations that can offer additional support and
information.
Not all forms of cancer or cancer treatment cause pain. If
pain occurs, many treatments are available to relieve it. If your doctor has
given you instructions or medicines to treat pain, be sure to follow them. You
may use
home treatment for pain to improve your physical and mental well-being. Be
sure to discuss any home treatment you use for pain with your doctor.
Medications
Your doctor may prescribe medicines that
will affect the growth of
non-Hodgkin's lymphoma and relieve your symptoms.
Treatment depends on:
The type of lymphoma. The kind of treatment
you have will depend on whether you have B-cell or T-cell lymphoma and whether
it is fast-growing or slow-growing.
The size of the tumor and
whether it is greater than
10 cm (3.9 in.). It also
matters where the lymphoma is located and what organs are
involved.
Your general health.
Whether you have had
lymphoma in the past (recurrent disease). While lymphoma that has come back
(recurred) may be controlled, it often is not curable.
For more information about medication treatments, see the
following topics:
Chemotherapy
often cures aggressive forms of non-Hodgkin's lymphoma. Even when cure is not
possible, such as with indolent lymphoma, chemotherapy may allow you to live a
long time without symptoms. A combination of chemotherapy medicines is
generally more effective than a single drug. The most commonly used combination
is called CHOP, which combines
cyclophosphamide,
doxorubicin,
vincristine, and
prednisone.
Your doctor may recommend
that you try treatment with a medicine known as a
monoclonal antibody (such as
rituximab). This medicine is used with CHOP for B-cell
lymphomas and helps you live a long time without symptoms.5
Depending on the type and the
stage of the lymphoma, chemotherapy may be used alone
or in combination with
radiation therapy.
Sometimes a person may
take one chemotherapy combination for several cycles and later switch to a
different one if the first treatment combination does not seem to be
working.
Chemotherapy causes many side effects. These side effects
are usually temporary and go away when treatment is stopped. Your doctor may
prescribe
medicines to control nausea and vomiting from
chemotherapy. Older adults may find side effects more difficult to tolerate.
Side effects may also cause more problems if you have other diseases, such as
diabetes,
chronic lung disease, or
coronary artery disease. You may not be able to become
pregnant or father a child after chemotherapy treatment. Discuss fertility
issues with your doctor before starting treatment. Chemotherapy medicines can
also cause birth defects. If you are pregnant or wish to father a child,
discuss the risk of birth defects with your doctor before using any
chemotherapy medicine.
Survival rates have improved as a result of
clinical trials. Clinical trials provide evidence
about new medicines and treatments that may help people who have non-Hodgkin's
lymphoma live longer and have a better quality of life. If you are interested
in taking part in a clinical trial, check with your doctor to see if there are
any clinical trials available in your area.
Your doctor may use
the term "remission" instead of "cure" when talking about the effectiveness of
your treatment. Although many people with non-Hodgkin's lymphoma are
successfully treated, doctors use the term remission because cancer can return.
It is important to discuss the possibility of recurrence with your
doctor.
Because of recent
improvements in body scans (such as the
CT scan,
MRI, and
PET scan), exploratory surgery is rarely used to stage
NHL.
Other Treatment
Radiation therapy
is often the treatment of choice for early-stage or nonaggressive (indolent)
non-Hodgkin's lymphoma (NHL). Radiation therapy may be
used alone or combined with other treatment options, such as chemotherapy, for
later or more advanced NHL.
Stem cell transplant (also called bone marrow transplant) is used to treat
relapsed aggressive NHL. One study showed that stem cell transplant improved
survival rates in people with aggressive NHL.6
A growth factor called G-CSF may be used along with chemotherapy for
newly diagnosed NHL. G-CSF is a protein that is produced naturally in the body.
G-CSF can help you tolerate chemotherapy better and have less risk for serious
infections.
What to think about
Radiation therapy often cures
early-stage or nonaggressive (indolent) non-Hodgkin's lymphoma.
Survival rates have improved as a result of
clinical trials. Clinical trials provide evidence
about new medicines and treatments that may help people who have non-Hodgkin's
lymphoma live longer and have a better quality of life. If you are interested
in taking part in a clinical trial, check with your doctor to see if there are
any clinical trials available in your area.
Your doctor may use
the term "remission" instead of "cure" when talking about the effectiveness of
your treatment. Although many people with non-Hodgkin's lymphoma are
successfully treated, doctors use the term remission because cancer can return.
It is important to discuss the possibility of recurrence with your
doctor.
Palliative care
If your
non-Hodgkin's lymphoma gets worse, you may want to
think about
palliative care. Palliative care is a kind of care for
people who have illnesses that do not go away and often get worse over time. It
is different from care to cure your illness, called curative treatment.
Palliative care focuses on improving your quality of life-not just in your body
but also in your mind and spirit. Some people combine palliative care with
curative care.
Palliative care may help you manage symptoms or
side effects from treatment. It could also help you cope with your feelings
about living with a long-term illness, make future plans around your medical
care, or help your family better understand your illness and how to support
you.
If you are interested in palliative care, talk to your
doctor. He or she may be able to manage your care or refer you to a doctor who
specializes in this type of care.
Non-Hodgkin's lymphoma is often
a progressive condition. If you have been diagnosed with NHL, you may wish to
discuss with your family and your doctor the health care and other legal issues
that arise near the end of life.
A time may come when your goals
or the goals of your loved ones may change from treating or curing an illness
to maintaining comfort and dignity. You may find it helpful and comforting to
state your health care choices in writing (with an
advance directive or living will) while you are still
able to make and communicate these decisions. Think about your treatment
options and which kind of treatment will be best for you. You may wish to
choose a
health care agent to make and carry out decisions
about your care if you become unable to speak for yourself. For more
information, see the topic
Care at the End of Life.
Other Places To Get Help
Organizations
Leukemia and Lymphoma Society
1311 Mamaroneck Avenue
White Plains, NY 10605
Phone:
1-800-955-4572 (914) 949-5213
Fax:
(914) 949-6691
Web Address:
http://www.leukemia.org
The Leukemia and Lymphoma Society is the world's largest voluntary
health organization dedicated to funding blood cancer research, education, and
patient services. The Society's mission is to cure leukemia, lymphoma,
Hodgkin's lymphoma, and myeloma and to improve the quality of life for patients
and their families.
American Cancer Society
Phone:
1-800-ACS-2345 (1-800-227-2345)
TDD:
1-866-228-4327 (toll-free)
Web Address:
www.cancer.org
The American Cancer Society conducts educational programs and
offers many services to people with cancer and to their families. Staff at the
toll-free numbers have information about services and activities in local areas
and can provide referrals to local ACS divisions.
Cancer.Net
Phone:
1-888-651-3036 (571) 483-1300
Fax:
(571) 366-9530
E-mail:
foundation@asco.org
Web Address:
www.cancer.net
Cancer.Net is the information Web site of the American
Society of Clinical Oncology (ASCO) for people living with cancer and for those
who care for them. ASCO is the world's leading professional organization
representing physicians of all oncology subspecialties. Cancer.Net provides
current oncologist-approved information on living with cancer.
National Cancer Institute (NCI)
NCI Publications Office
6116 Executive Boulevard
Suite 3036A
Bethesda, MD 20892-8322
Phone:
1-800-4-CANCER (1-800-422-6237) 9:00 a.m. to 4:30 p.m. EST, Monday through Friday
TDD:
1-800-332-8615
E-mail:
cancergovstaff@mail.nih.gov
Web Address:
www.cancer.gov (or
https://cissecure.nci.nih.gov/livehelp/welcome.asp# for live help
online)
The National Cancer Institute (NCI) is a U.S. government agency
that provides up-to-date information about the prevention, detection, and
treatment of cancer. NCI also offers supportive care to people with cancer and
to their families. NCI information is also available to doctors, nurses, and
other health professionals. NCI provides the latest information about clinical
trials. The Cancer Information Service, a service of NCI, has trained staff
members available to answer questions and send free publications.
Spanish-speaking staff members are also available.
References
Citations
Fisher RI, et al. (2005). Non-Hodgkin's lymphomas. In
VT DeVita Jr et al., eds., Cancer: Principles and Practice of Oncology, 7th ed., pp. 1957-1997. Philadelphia: Lippincott Williams and
Williams.
American Cancer Society (2005). Cancer Facts and Figures 2005, pp. 1-21. Atlanta: American Cancer Society. Also
available online:
http://www.cancer.org/downloads/STT/CAFF2005f4PWSecured.pdf.
Ardeshna KM, et al. (2003). Long-term effect of a
watch and wait policy versus immediate systemic treatment for asymptomatic
advanced-stage non-Hodgkin lymphoma: A randomised controlled trial.
Lancet, 362(9383): 516-522.
Coiffier B, et al. (2002). CHOP chemotherapy plus
rituximab compared with CHOP alone in elderly patients with diffuse
large-B-cell lymphoma. New England Journal of Medicine,
346(4): 235-242.
Milpied N, et al. (2004). Initial treatment of
aggressive lymphoma with high-dose chemotherapy and autologous stem-cell
support. New England Journal of Medicine, 350(13):
1287-1295.
Other Works Consulted
American Joint Committee on Cancer (2002). Lymphoid
neoplasms. AJCC Cancer Staging Manual, 6th ed., pp.
393-406. New York: Springer-Verlag.
Bierman PJ, et al. (2008). Non-Hodgkin's lymphomas. In
L Goldman, D Ausiello, eds., Cecil Textbook of Medicine,
23rd ed., pp. 1408-1419. Philadelphia: Saunders Elsevier.
Copson ER, Kerr JP (2006). Non-Hodgkin's lymphoma
(diffuse large B cell lymphoma), search date April 2006. Online version of
BMJ Clinical Evidence. Also available online:
http://www.clinicalevidence.com.
Foon KA, Fisher RI (2006). The non-Hodgkin lymphomas.
In MA Lichtman et al., eds., Williams Hematology, 7th
ed., pp. 1407-1459. New York: McGraw-Hill.
This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
Fisher RI, et al. (2005). Non-Hodgkin's lymphomas. In
VT DeVita Jr et al., eds., Cancer: Principles and Practice of Oncology, 7th ed., pp. 1957-1997. Philadelphia: Lippincott Williams and
Williams.
American Cancer Society (2005). Cancer Facts and Figures 2005, pp. 1-21. Atlanta: American Cancer Society. Also
available online:
http://www.cancer.org/downloads/STT/CAFF2005f4PWSecured.pdf.
Ardeshna KM, et al. (2003). Long-term effect of a
watch and wait policy versus immediate systemic treatment for asymptomatic
advanced-stage non-Hodgkin lymphoma: A randomised controlled trial.
Lancet, 362(9383): 516-522.
Coiffier B, et al. (2002). CHOP chemotherapy plus
rituximab compared with CHOP alone in elderly patients with diffuse
large-B-cell lymphoma. New England Journal of Medicine,
346(4): 235-242.
Milpied N, et al. (2004). Initial treatment of
aggressive lymphoma with high-dose chemotherapy and autologous stem-cell
support. New England Journal of Medicine, 350(13):
1287-1295.
