At Wilmot Cancer Institute, Dr. Patrick Reagan leads one of the first teams in the country to provide CAR T-cell therapy for patients with advanced diffuse large B-cell lymphoma.
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Lymphoma is the most common type of blood cancer in the U.S. and can be divided into two major types: Hodgkin and non-Hodgkin lymphoma. It starts in a part of the immune system known as the lymph system. Lymph tissue and cells are located throughout the body, and when healthy they fight infection and disease.
Wilmot Cancer Institute has one of the best lymphoma programs in the country. Our physicians and scientists are experienced leaders in delivering the latest treatments for this type of cancer, as well as educating other lymphoma specialists and being involved in developing and testing new therapies in the laboratory and through clinical trials.
Hodgkin lymphoma has a classic type that accounts for 95 percent of all cases. Large, abnormal lymphocytes (white blood cells) collect in lymph nodes, and the disease can occur anywhere because lymph nodes are located throughout the body. Hodgkin lymphoma is often curable.
Non-Hodgkin lymphoma (NHL) forms in different types of white blood cells known as B-cells, T-cells, and NK cells. It can be slow-growing or aggressive. Accurately classifying NHL is important because approximately 60 different types exist. Some types of NHL include:
- Diffuse large B-cell lymphoma is the most common type, occurring in about one of every three cases of NHL. It is usually aggressive.
- Follicular lymphoma (FL) accounts for about one of every five cases of lymphoma. FL is often slow-growing but hard to cure. Wilmot scientists discovered a unique group of high-risk FL patients and are working to identify new approaches for this group. They also discovered a link to low vitamin D in more aggressive cases.
- Mantle cell lymphoma, which comprises only about five percent of lymphomas. It can be challenging to treat, but newer therapies are being developed. Marginal zone B-cell lymphoma accounts for five to 10 percent of lymphomas. One type is linked to infection by Helicobacter pylori, which also causes stomach ulcers.
- Burkitt lymphoma, which accounts for less than two percent of lymphomas. It is fast-growing, and linked to infection with the Epstein-Barr virus (also known as “mono”).
- Hairy cell leukemia. Despite the name, this is a rare lymphoma, not leukemia. Wilmot is one of only 23 institutions in the world with a Center of Excellence.
- Peripheral (PTCL) and Cutaneous (CTCL) T-cell lymphomas. These types have some overlapping features: they both start in a type of white blood cell that helps the body fight infection. However, PTCL is rare and aggressive, whereas CTCL is a slow-growing skin lymphoma.
- Chronic lymphocytic leukemia (CLL) usually progresses more slowly and is a common type of lymphoma occurring during or after middle age.
NHL is diagnosed in more than 72,000 people annually. The average risk of developing it is about one in 50. Death rates have been going down since the 1990s. Hodgkin disease is rare. About 8,500 new cases are diagnosed annually and about 15 percent of the cases occur in children and teenagers.
Causes and risk factors
Aging is an important risk factor because about 95 percent of lymphoma cases occur in adults and about half of those are 66 or older. More on risk factors:
People in early adulthood (ages 15-40) or late adulthood (ages 55 or older) are at greater risk. Viral infections such as Epstein-Barr (mononucleosis) and HIV also increase a person’s risk of Hodgkin lymphoma. Those who have a first-degree relative (parent, sibling) with the disease are more likely to get it; the risk is very high for an identical twin. Hodgkin disease is diagnosed slightly more often in males than females.
People who are 60 and older are at an increased risk. White people tend to get the disease more than African Americans or other races and ethnicities. Exposure to certain chemicals, such as benzene, as well as herbicides and insecticides, increases the risk. Having an immune system deficiency or an autoimmune disorder also boosts the risk of NHL, as does infections, like H. Pylori. Obesity and consuming a diet high in fat and meats may increase the chances of getting this disease.
For most people it’s not possible to prevent lymphoma. However, it helps to keep the immune system healthy by avoiding smoking, or shared needles and unprotected sex (which can lead to HIV), and by eating a healthy diet and exercising.