Aggressive non-Hodgkin's lymphoma
Aggressive non-Hodgkin's lymphoma is one of the two main classifications of non-Hodgkin's lymphoma, the other being indolent. Aggressive non-Hodgkin's lymphomas are sometimes known as fast-growing or high-grade non-Hodgkin's lymphomas.
Aggressive non-Hodgkin's lymphomas are sometimes known as fast-growing, or high-grade, non-Hodgkin's lymphomas.
As these names suggest, aggressive non-Hodgkin's lymphomas grow quickly. Because of this, patients are likely to notice symptoms and to go to their doctor, and so be referred for specialist treatment at a relatively early stage of the illness.
Although the name 'aggressive' sounds very frightening, these lymphomas often respond very well to treatment. Even patients whose disease does not respond well to first-line, standard treatment, often do well with high-dose chemotherapy and stem cell transplants. In fact, aggressive non-Hodgkin's lymphomas are more likely to be completely cured than indolent non-Hodgkin's lymphomas.
In order to predict how well a patient will respond to treatment, and their likelihood of experiencing a relapse, doctors often use the International Prognostic Index (IPI). This consists of a list of five factors:
Treatments are available for all types of non-Hodgkin's lymphoma. In the case of aggressive non-Hodgkin's lymphoma, a complete cure is possible in between 40% and 75% of cases. Even in those patients who are not cured, a 'remission' (disease-free period) can often be achieved.
The type of treatment used will depend on many things, including:
It is important that the patient attends follow-up appointments for check-ups and tests, even if the lymphoma has apparently been cured or a remission achieved. A significant number of aggressive non-Hodgkin's lymphomas relapse, and further treatment may be needed.
Patients who are diagnosed with early-stage aggressive non-Hodgkin's lymphoma are usually treated with combination chemotherapy, in which more than one chemotherapy drug is given. This treatment is frequently given in combination with the monoclonal antibody rituximab.
Radiotherapy is often given as well, either after the chemotherapy or at the same time. It is directed specifically at any affected lymph nodes.
Although it is not possible to predict a patient's response, treatment of early-stage aggressive non-Hodgkin's lymphoma achieves a cure or a 'remission' (disease-free period) in 80% or more of patients.
Patients who are diagnosed with advanced-stage aggressive non-Hodgkin's lymphoma are given similar chemotherapy to early-stage patients. Radiotherapy may be given as well.
This standard treatment achieves a cure in between 40% and 70% of cases, although the patient's response to treatment will be different in every case.
In patients with non-Hodgkin's lymphoma that does not respond well to treatment, or whose disease relapses, further treatment is needed. High-dose chemotherapy may be tried and a peripheral blood stem cell transplant may be performed. This is can achieve a cure in roughly between 30% and 50% of patients.
If treatment is not successful, or is not possible, then medical management is likely to be aimed at controlling symptoms or at being palliative.
For more information on this topic, see How non-Hodgkin's lymphoma is treated.