Overview of care for adult survivors of non-Hodgkin lymphoma
- Matthew S Davids, MD, MMSc
Matthew S Davids, MD, MMSc
- Instructor in 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.
- SEER Database http://seer.cancer.gov/ (Accessed on June 27, 2014).
- Müller AM, Ihorst G, Mertelsmann R, Engelhardt M. Epidemiology of non-Hodgkin's lymphoma (NHL): trends, geographic distribution, and etiology. Ann Hematol 2005; 84:1.
- Blaes AH, Ma L, Zhang Y, Peterson BA. Quality of life appears similar between survivors of indolent and aggressive non-Hodgkin lymphoma. Leuk Lymphoma 2011; 52:2105.
- Smith SK, Zimmerman S, Williams CS, Zebrack BJ. Health status and quality of life among non-Hodgkin lymphoma survivors. Cancer 2009; 115:3312.
- Oerlemans S, Mols F, Nijziel MR, et al. The impact of treatment, socio-demographic and clinical characteristics on health-related quality of life among Hodgkin's and non-Hodgkin's lymphoma survivors: a systematic review. Ann Hematol 2011; 90:993.
- Travis LB, Curtis RE, Glimelius B, et al. Second cancers among long-term survivors of non-Hodgkin's lymphoma. J Natl Cancer Inst 1993; 85:1932.
- Tward JD, Wendland MM, Shrieve DC, et al. The risk of secondary malignancies over 30 years after the treatment of non-Hodgkin lymphoma. Cancer 2006; 107:108.
- Pirani M, Marcheselli R, Marcheselli L, et al. Risk for second malignancies in non-Hodgkin's lymphoma survivors: a meta-analysis. Ann Oncol 2011; 22:1845.
- Lorenzo Bermejo J, Pukkala E, Johannesen TB, et al. Age-time risk patterns of solid cancers in 60 901 non-Hodgkin lymphoma survivors from Finland, Norway and Sweden. Br J Haematol 2014; 164:675.
- Hemminki K, Lenner P, Sundquist J, Bermejo JL. Risk of subsequent solid tumors after non-Hodgkin's lymphoma: effect of diagnostic age and time since diagnosis. J Clin Oncol 2008; 26:1850.
- Mudie NY, Swerdlow AJ, Higgins CD, et al. Risk of second malignancy after non-Hodgkin's lymphoma: a British Cohort Study. J Clin Oncol 2006; 24:1568.
- Morton LM, Curtis RE, Linet MS, et al. Second malignancy risks after non-Hodgkin's lymphoma and chronic lymphocytic leukemia: differences by lymphoma subtype. J Clin Oncol 2010; 28:4935.
- Toda K, Shibuya H, Hayashi K, Ayukawa F. Radiation-induced cancer after radiotherapy for non-Hodgkin's lymphoma of the head and neck: a retrospective study. Radiat Oncol 2009; 4:21.
- Sanna G, Lorizzo K, Rotmensz N, et al. Breast cancer in Hodgkin's disease and non-Hodgkin's lymphoma survivors. Ann Oncol 2007; 18:288.
- Hequet O, Le QH, Moullet I, et al. Subclinical late cardiomyopathy after doxorubicin therapy for lymphoma in adults. J Clin Oncol 2004; 22:1864.
- Moser EC, Noordijk EM, van Leeuwen FE, et al. Long-term risk of cardiovascular disease after treatment for aggressive non-Hodgkin lymphoma. Blood 2006; 107:2912.
- Murbraech K, Smeland KB, Holte H, et al. Heart Failure and Asymptomatic Left Ventricular Systolic Dysfunction in Lymphoma Survivors Treated With Autologous Stem-Cell Transplantation: A National Cross-Sectional Study. J Clin Oncol 2015; 33:2683.
- Blanco JG, Sun CL, Landier W, et al. Anthracycline-related cardiomyopathy after childhood cancer: role of polymorphisms in carbonyl reductase genes--a report from the Children's Oncology Group. J Clin Oncol 2012; 30:1415.
- Visscher H, Ross CJ, Rassekh SR, et al. Pharmacogenomic prediction of anthracycline-induced cardiotoxicity in children. J Clin Oncol 2012; 30:1422.
- Elis A, Tevet A, Yerushalmi R, et al. Fertility status among women treated for aggressive non-Hodgkin's lymphoma. Leuk Lymphoma 2006; 47:623.
- Dann EJ, Epelbaum R, Avivi I, et al. Fertility and ovarian function are preserved in women treated with an intensified regimen of cyclophosphamide, adriamycin, vincristine and prednisone (Mega-CHOP) for non-Hodgkin lymphoma. Hum Reprod 2005; 20:2247.
- Kiserud CE, Fosså A, Bjøro T, et al. Gonadal function in male patients after treatment for malignant lymphomas, with emphasis on chemotherapy. Br J Cancer 2009; 100:455.
- Steffens M, Beauloye V, Brichard B, et al. Endocrine and metabolic disorders in young adult survivors of childhood acute lymphoblastic leukaemia (ALL) or non-Hodgkin lymphoma (NHL). Clin Endocrinol (Oxf) 2008; 69:819.
- Correa DD, DeAngelis LM, Shi W, et al. Cognitive functions in survivors of primary central nervous system lymphoma. Neurology 2004; 62:548.
- Rizzo JD, Wingard JR, Tichelli A, et al. Recommended screening and preventive practices for long-term survivors after hematopoietic cell transplantation: joint recommendations of the European Group for Blood and Marrow Transplantation, the Center for International Blood and Marrow Transplant Research, and the American Society of Blood and Marrow Transplantation. Biol Blood Marrow Transplant 2006; 12:138.
- Carson KR, Evens AM, Richey EA, et al. Progressive multifocal leukoencephalopathy after rituximab therapy in HIV-negative patients: a report of 57 cases from the Research on Adverse Drug Events and Reports project. Blood 2009; 113:4834.
- Correa DD, Rocco-Donovan M, DeAngelis LM, et al. Prospective cognitive follow-up in primary CNS lymphoma patients treated with chemotherapy and reduced-dose radiotherapy. J Neurooncol 2009; 91:315.
- Smith SK, Zimmerman S, Williams CS, et al. Post-traumatic stress outcomes in non-Hodgkin's lymphoma survivors. J Clin Oncol 2008; 26:934.
- Arora NK, Jensen RE, Sulayman N, et al. Patient-physician communication about health-related quality-of-life problems: are non-Hodgkin lymphoma survivors willing to talk? J Clin Oncol 2013; 31:3964.
- Kriege M, Brekelmans CT, Boetes C, et al. Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition. N Engl J Med 2004; 351:427.
- Saslow D, Boetes C, Burke W, et al. American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin 2007; 57:75.
- Bellizzi KM, Rowland JH, Arora NK, et al. Physical activity and quality of life in adult survivors of non-Hodgkin's lymphoma. J Clin Oncol 2009; 27:960.
- Vallance JK, Courneya KS, Jones LW, Reiman T. Differences in quality of life between non-Hodgkin's lymphoma survivors meeting and not meeting public health exercise guidelines. Psychooncology 2005; 14:979.
- Grunfeld E, Earle CC. The interface between primary and oncology specialty care: treatment through survivorship. J Natl Cancer Inst Monogr 2010; 2010:25.
- 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