Optimising lymphoma management: Multidisciplinary approaches and support systems

Lymphocytes are an important subset of white blood cells which have a central role in the immune system’s defence against pathogens such as bacteria and viruses. A type of blood cancer, lymphoma develops when a mutation in normal lymphocytes transforms them into abnormal, cancerous cells. Lymphoma is broadly classified into two main types: Hodgkin Lymphoma (HL) and Non-Hodgkin Lymphoma (NHL).

In Malaysia, lymphoma was the fourth most common cancer and the seventh leading cause of cancer-related deaths in 2017-2021. [https://nci.moh.gov.my/images/pdf_folder/SUMMARY-OF-MALAYSIA-NATIONAL-CANCER-REGISTRY-REPORT-2017-2021.pdf, https://gco.iarc.who.int/media/globocan/factsheets/populations/458-malaysia-fact-sheet.pdf] Worldwide, NHL was the 10th most common cancer with more than half a million cases and about a quarter of a million deaths in 2022. [https://gco.iarc.who.int/media/globocan/factsheets/cancers/34-non-hodgkin-lymphoma-fact-sheet.pdf]

While HL is typically diagnosed in younger adults, NHL is more commonly seen in older adults and has many subtypes, including B-cell and T-cell lymphomas. HL can be differentiated from NHL based on the presence of Reed-Sternberg cells in HL but not in NHL. Although NHL is more prevalent than HL, men are at a higher risk of developing both types. In Malaysia, NHL is the sixth most common cancer among males and the seventh most common cancer among females. [https://gco.iarc.who.int/media/globocan/factsheets/populations/458-malaysia-fact-sheet.pdf]

Clinical haematologist and transplant physician Dr Hon Siong Leng highlighted the complexities of lymphoma and the critical importance of early detection and timely intervention. “Unlike normal lymphocytes, the abnormal cells replicate rapidly and have an extended lifespan. These cancerous cells spread through the blood and lymphatic systems, eventually growing in various body parts, including the lymph nodes, spleen, bone marrow, and other organs. As a result, patients with lymphoma will usually present with painless enlargement of lymph nodes or abnormal blood counts,” she explained.

Recognising early signs of lymphoma
Patients with lymphoma may experience a range of symptoms, such as prolonged fever (temperature >39.5^◦C) for unknown reason, unexpected weight loss, skin rash or itching, and profuse nocturnal sweating. It is crucial to recognise these symptoms early because timely diagnosis and early intervention can significantly improve treatment outcomes, said Hon.

While lymphoma can affect individuals of all ages, certain factors can increase the risk of developing the disease. The likelihood of developing lymphoma rises with age, especially NHL, with the median age of diagnosis being 67 years. [https://www.ncbi.nlm.nih.gov/books/NBK559328/]

However, age is just one of the many risk factors. People with weakened immune systems are more susceptible to lymphoma. This includes those who have undergone organ transplants in the past, and are on immunosuppressive medications, as well as individuals with infections such as HIV, AIDS or Epstein-Barr virus (EBV). [https://my.clevelandclinic.org/health/diseases/22225-lymphoma]

A family history of lymphoma and environmental factors also play a role in elevating the risk of lymphoma, Hon emphasised. Exposure to chemicals such as benzene, pesticides and herbicides has been linked to an increased risk of developing lymphoma. [https://tinyurl.com/2z25z6tm] Additionally, individuals who have previously undergone cancer treatment like chemotherapy or radiotherapy may face a higher likelihood of lymphoma later in life, she added.

Living with lymphoma: Survival rates and treatment options
The good news is that lymphoma is one of the highly curable forms of cancer. Hon noted that the overall cure rate for lymphoma can be as high as 80 percent, as even stage 4 patients have shown a cure rate of up to 70 percent. However, she said that the treatment options vary depending on the type and staging of lymphoma as well as the aggressiveness of the cancer. Commonly used treatment options include immunochemotherapy, radiation therapy, targeted therapy, autologous stem cell or bone marrow transplantation, and chimeric antigen receptor (CAR) T-cell therapy. Hence, it is important to consult with the specialist to tailor the treatment plan.

“A diagnosis of lymphoma can impact patients both mentally and physically. The side effects of treatment, coupled with the emotional toll of battling cancer, can affect a patient’s quality of life. However, people with lymphoma can manage these challenges by maintaining a balanced diet that includes lean protein, whole grains and full-fat dairy products,” said Hon.

Patients should consume well-cooked food during treatment and avoid traditional medicine to prevent potential interaction with mainstream treatment. Regarding daily activities, meditation or relaxation exercises like deep breathing exercises may reduce the stress and fatigue of the patients and further increase their quality of life. [https://my.clevelandclinic.org/health/diseases/22225-lymphoma] Joining a support group may also improve patients’ treatment outcomes by managing their symptoms and the treatment side effects as well as providing emotional and spiritual support, Hon added.