Overview of care for adult survivors of non-Hodgkin lymphoma
- Matthew S Davids, MD, MMSc
Matthew S Davids, MD, MMSc
- Assistant Professor of Medicine
- Harvard Medical School
- David C Fisher, MD
David C Fisher, MD
- Assistant Professor of Medicine
- Harvard Medical School
Non-Hodgkin lymphoma (NHL) consists of a diverse group of malignant neoplasms of the lymphoid tissues variously derived from B cell progenitors, T cell progenitors, mature B cells, or mature T cells. In the United States, NHL is the fifth most common malignancy and the sixth most common cause of cancer death . There are a growing number of long-term survivors of NHL. This is predominantly due to an increasing incidence and improved survival after initial treatment:
●Approximately 71,000 people are diagnosed with NHL in the United States each year, and the incidence of the disease is on the rise, doubling since the 1970s, with a continued 1 to 2 percent increase per year this century . These increases have been seen predominantly in high-grade, potentially curable subtypes .
●NHL is often a disease of middle-aged and older adults, a demographic that continues to increase in size as the life expectancy of the general population increases.
●Improvements in initial therapy have increased survival rates for some NHL histologies, such as diffuse large B cell lymphoma. NHL survivors now commonly live for many years after completing curative therapy.
Despite improvements in treatment, NHL survivors are at risk of developing long-term complications of intensive therapy, including second malignancies, cardiovascular disease, endocrine dysfunction, and cognitive sequelae.
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- PROGNOSIS AND NATURAL HISTORY
- OVERVIEW OF TREATMENT COMPLICATIONS
- Second malignancies
- Infertility and endocrine dysfunction
- - Gonadal dysfunction
- - Other endocrinopathies
- Neurologic and psychiatric complications
- POSTTREATMENT SURVEILLANCE
- Monitoring for relapse
- Monitoring for complications
- Lifestyle modifications
- COORDINATION OF CARE
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS