Hodgkin's the Disease

In Hodgkin's disease, cells in the lymphatic system become abnormal. They divide too rapidly and grow without any order or control. Because lymphatic tissue is present in many parts of the body, Hodgkin's disease can start almost anywhere. Hodgkin's disease may occur in a single lymph node, a group of lymph nodes, or, sometimes, in other parts of the lymphatic system such as the bone marrow and spleen. This type of cancer tends to spread in a fairly orderly way from one group of lymph nodes to the next group.
For example, Hodgkin's disease that arises in the lymph nodes in the neck spreads first to the nodes above the collarbones, and then to the lymph nodes under the arms and within the chest. Eventually, it can spread to almost any other part of the body.

Understanding Hodgkin's Disease

Cancer is a group of many related diseases that begin in cells, the body's basic unit of life. To understand Hodgkin's disease, it is helpful to know about normal cells and what happens when they become cancerous. The body is made up of many types of cells. Normally, cells grow and divide to produce more cells only when the body needs them. This orderly process helps keep the body healthy.
Sometimes cells keep dividing when new cells are not needed, creating a mass of extra tissue. This mass is called a growth or tumor. Tumors can be either benign (not cancerous) or malignant (cancerous).

What is Hodgkin's disease?

Hodgkin's disease is one of a group of cancers called lymphomas. Lymphoma is a general term for cancers that develop in the lymphatic system. Hodgkin's disease, an uncommon lymphoma, accounts for less than 1 percent of all cases of cancer in this country. Other cancers of the lymphatic system are called non-Hodgkin's lymphomas.
The lymphatic system is part of the body's immune system. It helps the body fight disease and infection. The lymphatic system includes a network of thin lymphatic vessels that branch, like blood vessels, into tissues throughout the body. Lymphatic vessels carry lymph, a colorless, watery fluid that contains infection-fighting cells called lymphocytes. Along this network of vessels are small organs called lymph nodes. Clusters of lymph nodes are found in the underarms, groin, neck, chest, and abdomen.
Other parts of the lymphatic system are the spleen, thymus, tonsils, and bone marrow. Lymphatic tissue is also found in other parts of the body, including the stomach, intestines, and skin.

What Affects the Biopsy Test

You may not be able to have the test if you:

• Have bleeding problems or are taking blood thinners such as aspirin, clopidogrel (Plavix), or warfarin (Coumadin).
• Can't be still during the procedure.

Sometimes not enough bone marrow fluid is collected in a bone marrow aspiration. This is called a dry tap. If this happens, a biopsy to obtain bone marrow tissue is usually done
     

• If you have an infection, a culture and sensitivity test of the bone marrow sample can be done. If the infection is caused by a bacteria or fungus, the sensitivity test will show which antibiotics will work best to treat the infection.
• Normal bone marrow in one site does not mean that all sites in the body are normal.

  

The Results of the Biopsy

A bone marrow aspiration and biopsy removes a small amount of bone and a small amount of fluid and cells from inside the bone (bone marrow). It is often done to find the reason for many blood disorders and may be used to find out if cancer or infection has spread to the bone marrow.

Biopsy results are usually ready in 1 to 7 days. But it may take several weeks to get the results if genetic tests are done on the sample. The bone is put into a solution that breaks down its calcium before it is stained. The bone marrow sample is often treated with special dyes (stains) to see any changes in the blood cells more clearly.

Bone marrow biopsy and aspiration

Normal:	The marrow has normal amounts of fat, connective tissue, and iron. Normal numbers of both mature and immature (growing) bone marrow cells are present.
	No signs of infection are seen.
	No cancer cells, such as leukemia, lymphoma, or multiple myeloma, are seen.
	No cancer cells have spread from other cancer sites, such as breast cancer.
Abnormal:	The cells in the bone marrow do not look normal.
	There are too many or too few bone marrow cells. The bone tissue does not look normal.
	Too much iron or too little iron (iron deficiency anemia) is seen in the bone marrow.
	Signs of infection are seen in the bone marrow.
	Cancer cells, such as leukemia, lymphoma, or multiple myeloma, are seen.
	The bone marrow has been replaced by scar tissue.

After the Biopsy

You will lie down for 30 to 60 minutes after the biopsy so the site can be checked for bleeding. If you had a sedative, you will need someone to drive you home after the biopsy.

You may feel sore at the biopsy site for several days. Ice packs to the site, walking, and pain medicine, such as acetaminophen (Tylenol), can be used to help you feel better.

Call your doctor immediately if you have:

• More tenderness, pain, redness, or swelling at the biopsy site.
• A fever.
• Bleeding or drainage, such as pus, from the biopsy site. If you are bleeding, put pressure on the site and call your doctor.

Risks involved with the Biopsy

Serious problems from a bone marrow aspiration or biopsy are not common. Problems may include:

• Bleeding from the biopsy site. People with bleeding problems have a higher chance for this. If you have bleeding problems, pressure will be put on the biopsy site for at least 10 minutes after the biopsy. In rare cases, you may be given a blood product (clotting factor or platelets) in a vein in your arm before the biopsy to prevent bleeding after the biopsy.
• Infection of skin or the bone (osteomyelitis) at the biopsy site.
• Injury to your heart, a lung, or a major blood vessel if the sample is taken from the breastbone (sternum). This complication is very rare. Samples are not often taken from the breastbone, so most people do not have to worry about this risk.

How the Biopsy will feel

This procedure may be painful, but only for a few seconds. You may feel a sharp sting and burn when the anesthetic numbs your skin over the aspiration or biopsy site. You may hear a crunching sound and feel pressure and some pain when the needle enters the bone. During an aspiration, you may feel a quick, shooting pain down your leg as the sample is taken.

The biopsy site may feel stiff or sore for several days after the biopsy. You may have a bruise on the site.

During the Biopsy Test

Blood samples from a vein in your arm may be taken before the bone marrow biopsy. In rare cases, you may be given a blood product (clotting factor or platelets) into a vein (IV) in your arm to prevent bleeding after the biopsy.

Adults usually have a sample of bone marrow fluid taken from the back of the pelvic bone. In rare cases a fluid sample is removed from the breastbone sternum  or from the front of the pelvic bone. Babies and young children may have the sample taken from the front of the lower leg bone, just below the knee. A bone marrow biopsy is only taken from the pelvic bone.

You may be given a sedative to help you relax. You will lie either on your side or facedown on your belly for the biopsy. It is important that you lie still in that position during the biopsy.

The skin over the aspiration site will be cleaned with a special solution and a medicine (local anesthetic) will be used to numb the area. Then the aspiration needle will be put through your skin and into your bone to reach the bone marrow. You need to lie very still while the sample is taken. The needle is then taken out. More than one sample may be needed, possibly from more than one place on your body, such as from both sides of the pelvic bone.

A bone marrow biopsy uses a special tool that twists into the bone. It is normal to feel pressure at the site and hear a crunching sound as the tool twists into the bone.

After the samples have been taken, pressure is put on the site to stop any bleeding. A bandage is put on the area.

How a Bone Marrow Biopsy is done

A bone marrow aspiration and biopsy is usually done by a hematologist, medical oncologist, internist, or pathologist, or by a specially trained technologist. A laboratory technologist may also help get the sample. This biopsy may be done in your doctor's office or in a hospital.

You may need to take off all or most of your clothes, depending on what part of the body the biopsy or aspiration is taken from. If needed, you will be given a gown to use during the biopsy.

A bone marrow aspiration, biopsy, or both are done to

• Look for the cause of problems with red blood cells, white blood cells, or platelets in people who have conditions such as thrombocytopenia, anemia, or an abnormal white blood cell count.
• Find blood disorders, such as leukemia, certain anemias, or problems that affect the bone marrow, such as multiple myeloma or polycythemia vera.
• Check to see if a known cancer, such as Hodgkin's lymphoma or non-Hodgkin's lymphoma, has spread to the bone marrow. This is part of what is called staging. It is done to find out if the cancer has spread and how much it has spread. This helps plan cancer treatment.
• Find infections or tumors that may start in or spread to the bone marrow. If you have an infection, a culture and sensitivity test of the bone marrow sample may be used to find out which antibiotics will work best to treat the infection.
• Find the best treatment for a bone marrow problem. Once treatment has been started, a bone marrow aspiration and biopsy may be done to see if the leukemia cells are gone, which means the treatment is working.
• Collect a sample of bone marrow for medical procedures, such as stem cell transplantation or chromosomal analysis.

Bone Marrow Aspiration and Biopsy

A bone marrow biopsy removes a small amount of bone and a small amount of fluid and cells from inside the bone (bone marrow). A bone marrow aspiration removes only the marrow. These tests are often done to find the reason for many blood disorders and may be used to find out if cancer or infection has spread to the bone marrow.

• Bone marrow aspiration removes a small amount of bone marrow fluid and cells through a needle put into a bone. The bone marrow fluid and cells are checked for problems with any of the blood cells made in the bone marrow. Cells can be checked for chromosome problems. Cultures can also be done to look for infection.
• A bone marrow biopsy removes bone with the marrow inside to look at under a microscope. The aspiration (taking fluid) is usually done first, and then the biopsy.

A bone marrow aspiration can also be done to collect bone marrow for medical procedures, such as stem cell transplant or chromosomal analysis. For a stem cell transplant, bone marrow aspiration will be done at several places on the body (generally from the back of the pelvic bone) to remove enough bone marrow cells for the transplant to work.

Non-Hodgkin's Lymphoma - Exams and Tests

If non-Hodgkin's lymphoma (NHL) is suspected, your doctor will ask about your medical history and perform a physical exam. This exam includes checking for enlarged lymph nodes in your neck, underarm, and groin.

Diagnostic tests

A tissue sample (biopsy) is needed to make a diagnosis. A biopsy for non-Hodgkin's lymphoma is usually taken from a lymph node, but other tissues may be sampled as well.

A bone marrow aspiration and biopsy is usually done to find out if lymphoma cells are present in the bone marrow.

Your doctor may also order other tests, including:

• Blood tests, such as a chemistry screen to measure the levels of several substances in the blood and a CBC (complete blood count) to provide information about the kinds and numbers of cells in the blood.
• A chest X-ray, to provide a picture of the inside of the chest.
• A CT scan or MRI, to provide detailed pictures of the inside of the chest, abdomen, and pelvis.
• A PET scan, to show areas of increased metabolic activity. Metabolic activity is often high in cancer cells.
• Lab tests, such as flow cytometry, that check the types of cells in a biopsy sample. These tests help your doctor find out the type of lymphoma.
• Lumbar puncture (also called a spinal tap), to find out whether lymphoma cells are in the fluid (cerebrospinal fluid, or CSF) surrounding your brain and spinal cord.

Non-Hodgkin's Lymphoma Medications for treatment

Your doctor may prescribe medicines that will affect the growth of non-Hodgkin's lymphoma and relieve your symptoms.

Chemotherapy

Chemotherapy may be used alone or with radiation therapy. Sometimes a combination of chemotherapy medicines is more effective than a single drug.

The most commonly used combination is called CHOP. It combines four medicines: cyclophosphamide, doxorubicin, vincristine, and prednisone.

Your doctor will work with you to find the best medicine for the type of lymphoma you have.

Chemotherapy causes many side effects.  Your doctor may prescribe medicines to control nausea and vomiting from chemotherapy.

Monoclonal antibodies

Targeted therapy uses monoclonal antibodies in medicine that is injected into the body so these antibodies can attach to cancer cells and destroy them. The monoclonal antibodies used to treat NHL include:Rituximab (Rituxan).Alemtuzumab (Campath).Ibritumomab (Zevalin).Tositumomab (Bexxar).

Other medicines Some treatments use interferon or antibiotic medicines. Your doctor will suggest the treatment that works best for your kind of lymphoma.

Non-Hodgkin's Lymphoma Diagnoses Are Up; So Are Options

54,000 Americans diagnosed each year with non-Hodgkin's lymphoma (NHL) - once uncommon cancers of the immune system. The rate of NHL in the U.S. has nearly doubled since the 1970s. For many people with these cancers, relapse scenarios are all too familiar. But treatment options for NHL are on the rise.

Rising rates of non-Hodgkin's lymphoma in the U.S. are likely due to more widespread use of drugs that affect the immune system, according to Stephanie Gregory, MD, oncologist and professor of medicine at Rush University Medical Center.

"We're helping people with autoimmune diseases and organ transplants to live longer," part of the cost is "an increase in the incidence of lymphomas."

Non-Hodgkin's lymphoma can defy generalization, because there are over 20 different forms of the disease.

"You could be in a room with 100 people with lymphoma and at most only 30 people would have the same thing you're dealing with," John Leonard, MD, director of the Cornell Center for Lymphoma and Myeloma at Weill Cornell Medical Center, stated.

Lymphomas result when certain blood cells, called lymphocytes, multiply and refuse to obey normal signals -- especially the command to die normally. Lymphocytes build up, especially in lymph nodes, and eventually cause serious problems by their size and their ineffectiveness at fighting infections, which is their usual job.

For slow-growing lymphomas, long-term survival is common, although they cannot be cured. More aggressive tumors are more dangerous, but a permanent cure is possible. The lymphoma type, its effects, and its growth rate determine the best treatment.

The most common types of NHL are:

• The usually slow-growing follicular lymphoma
• The often more aggressive diffuse large B-cell lymphoma

Less common types include:

• Mantle cell lymphoma
• Small lymphocytic lymphoma
• Burkitt's lymphoma

The Collection of Donor Stem Cells

A stem cell transplant is usually done after chemotherapy and radiation is complete. The stem cells are delivered into your bloodstream usually through a tube called a central venous catheter. The process is similar to getting a blood transfusion. The stem cells travel through the blood into the bone marrow. Most times, no surgery is needed.
Donor stem cells can be collected in two ways:

• Bone marrow harvest. This minor surgery is done under general anesthesia. This means the donor will be asleep and pain-free during the procedure. The bone marrow is removed from the back of both hip bones. The amount of marrow removed depends on the weight of the person who is receiving it.
• Leukapheresis. First, the donor is given 5 days of shots to help stem cells move from the bone marrow into the blood. During leukapheresis, blood is removed from the donor through an IV line in a vein. The part of white blood cells that contains stem cells is then separated in a machine and removed to be later given to the recipient. The red blood cells are returned to the donor.

Bone marrow transplants

A bone marrow transplant is a procedure to replace damaged or destroyed bone marrow with healthy bone marrow stem cells.
Bone marrow is the soft, fatty tissue inside your bones. Stem cells are immature cells in the bone marrow that give rise to all of your blood cells.
There are three kinds of bone marrow transplants:

• Autologous bone marrow transplant: The term auto means self. Stem cells are removed from you before you receive high-dose chemotherapy or radiation treatment. The stem cells are stored in a freezer (cryopreservation). After high-dose chemotherapy or radiation treatments, your stems cells are put back in your body to make (regenerate) normal blood cells. This is called a rescue transplant.
• Allogeneic bone marrow transplant: The term allo means other. Stem cells are removed from another person, called a donor. Most times, the donor's genes must at least partly match your genes. Special blood tests are done to see if a donor is a good match for you. A brother or sister is most likely to be a good match. Sometimes parents, children, and other relatives are good matches. Donors who are not related to you may be found through national bone marrow registries.
• Umbilical cord blood transplant: This is a type of allogeneic transplant. Stem cells are removed from a newborn baby's umbilical cord right after birth. The stem cells are frozen and stored until they are needed for a transplant. Umbilical cord blood cells are very immature so there is less of a need for matching. But blood counts take much longer to recover.

Scientists ‘reset’ human stem cells to ‘blank state’

Scientists have learned to “reset” human stem cells to their earliest state. This breakthrough gives hope for millions of people suffering from incurable conditions, like Parkinson’s Disease, as scientists hope their success would lead to cures.
British and Japanese scientists have managed to reboot stem cells to the state equivalent 7 to 10-day old embryo, before it implants in the womb.
“These cells may represent the real starting point for formation of tissues in the human embryo,” said Austin Smith, director of the Britain's Cambridge Stem Cell Institute, who co-led the research. “Capturing embryonic stem cells is like stopping the developmental clock at the precise moment before they begin to turn into distinct cells and tissues.”
Until now it was only possible to produce what in scientific language is called pluripotent stem cells in the lab either from cells extracted from a very early stage embryo or from adult cells that have been induced into a pluripotent state.
Human pluripotent stem cells are first of all valuable because of their unique capability to become any of the cells and tissues in the body.
It is much easier to control the process of generating stem cells in mouse cells which can be frozen in a state in their naïve or “blank state” using a protein called LIF. But this is not the case with human cells, which are not as responsive to LIF. That means they require different control, involves switching key genes on and off.
For this reason scientists have been unable to generate human pluripotent cells that are as primitive or as consistent as mouse embryonic stem cells.
To avoid this problem, the scientists introduced two genes – NANOG and KLF2 – which caused a network of genes controlling the cell to reboot and induce the early pluripotent state.
So now, those “reset cells” share many of the characteristics of authentic naïve embryonic stem cells isolated from mice, suggesting that they represent the earliest stage of development.

 

Taking Part in Cancer Research

Doctors all over the country are studying new ways to treat lymphoma. Clinical trials (research studies in which people volunteer to take part) find out whether promising approaches to treatment are safe and effective. Research already has led to advances.
Researchers are studying many types of treatments for lymphoma:

• Chemotherapy: Doctors are testing new drugs that kill cancer cells. They are working with many drugs and drug combinations. They also are looking at ways of combining drugs with other treatments, such as biological therapy.
• Radiation therapy: Doctors are testing radiation treatment alone and with chemotherapy.
• Biological therapy: New types of biological therapy are under study. For example, researchers are making cancer vaccines that may help the immune system kill lymphoma cells. Also, doctors are studying a type of biological therapy that delivers radiation directly to cancer cells.
• Stem cell transplantation: Doctors are studying stem cell transplantation in people with newly diagnosed lymphoma and those who have already been treated.

People who join clinical trials may be among the first to benefit if a new approach is effective. And even if participants do not benefit directly, they still help doctors learn more about lymphoma and how to control it. Although clinical trials may pose some risks, researchers do all they can to protect their patients.
If you are interested in being part of a clinical trial, you should talk with your doctor.

Just because people say stem cells helped them doesn’t mean they did.

There are three main reasons why a person might feel better that are unrelated to the actual stem cell treatment: the ‘placebo effect’, accompanying treatments, and natural fluctuations of the disease or condition. The intense desire or belief that a treatment will work can cause a person to feel like it has and to even experience positive physical changes, such as improved movement or less pain. This phenomenon is called the placebo effect. Even having a positive conversation with a doctor can cause a person to feel improvement. Likewise, other techniques offered along with stem cell treatment—such as changes to diet, relaxation, physical therapy, medication, etc.—may make a person feel better in a way that is unrelated to the stem cells. Also, the severity of symptoms of many conditions can change over time, resulting in either temporary improvement or decline, which can complicate the interpretation of the effectiveness of treatments. These factors are so widespread that without testing in a controlled clinical study, where a group that receives a treatment is carefully compared against a group that does not receive this treatment, it is very difficult to determine the real effect of any therapy. Be wary of clinics that measure or advertise their results primarily through patient testimonials.

Currently, there are very few widely accepted stem cell therapies

The range of diseases where stem cell treatments have been shown to be beneficial in responsibly conducted clinical trials is still extremely restricted. The best defined and most extensively used is blood stem cell transplantation to treat diseases and conditions of the blood and immune system, or to restore the blood system after treatments for specific cancers. Some bone, skin and corneal diseases or injuries can be treated with grafting of tissue that depends upon stem cells from these organs. These therapies are also generally accepted as safe and effective by the medical community

A single Stem Cell Treatment will not work on a multitude of unrelated diseases

Each type of stem cell fulfills a specific function in the body and cannot be expected to make cell types from other tissues. Thus, it is unlikely that a single type of stem cell treatment can treat multiple unrelated conditions, such as diabetes and Parkinson’s disease. The underlying causes are very different and different cell types would need to be replaced to treat each condition. It is critical that the cell type used as a treatment be appropriate to the specific disease or condition.

Embryonic stem cells may one day be used to generate treatments for a range of human diseases. However, embryonic stem cells themselves cannot directly be used for therapies as they would likely cause tumors and are unlikely to become the cells needed to regenerate a tissue on their own. They would first need to be coaxed to develop into specialized cell types before transplantation. A major warning sign that a clinic may not be credible is when treatments are offered for a wide variety of conditions but rely on a single cell type.

There are different types of Stem Cells

There are many different types of stem cells that come from different places in the body or are formed at different times in our lives. These include embryonic stem cells that exist only at the earliest stages of development and various types of ‘tissue-specific’ or ‘adult’ stem cells that appear during fetal development and remain in our bodies throughout life.

Our bodies use different types of tissue-specific stem cells to fit a particular purpose. Tissue-specific stem cells are limited in their potential and largely make the cell types found in the tissue from
which they are derived. For example, the blood-forming stem cells (or hematopoietic stem cells) in the bone marrow regenerate the blood, while neural stem cells in the brain make brain cells. A neural stem cell won’t spontaneously make a blood cell and likewise a hematopoietic stem cell won’t spontaneously make a brain cell. Thus, it is unlikely that a single cell type could be used to treat a multitude of unrelated diseases that involve different tissues or organs. Be wary of clinics that offer treatments with stem cells that originate from a part of the body that is different from the part being treated

The need for Follow-up Care

You'll need regular checkups after treatment for non-Hodgkin lymphoma. Your doctor will watch your recovery closely and check for recurrence of the lymphoma. Checkups help make sure that any changes in your health are noted and treated as needed. Checkups may include a physical exam, lab tests, chest x-rays, and other procedures. Between scheduled visits, you should contact the doctor right away if you have any health problems.

Nutrition and Physical Activity

It's important for you to take care of yourself by eating well and staying as active as you can.
You need the right amount of calories to maintain a good weight. You also need enough protein to keep up your strength. Eating well may help you feel better and have more energy.
Sometimes, especially during or soon after treatment, you may not feel like eating. You may be uncomfortable or tired. You may find that foods do not taste as good as they used to. In addition, the side effects of treatment (such as poor appetite, nausea, vomiting, or mouth sores) can make it hard to eat well. Your doctor, a registered dietitian, or another health care provider can suggest ways to deal with these problems.
Many people find they feel better when they stay active. Walking, yoga, swimming, and other activities can keep you strong and increase your energy. Exercise may reduce nausea and pain and make treatment easier to handle. It also can help relieve stress. Whatever physical activity you choose, be sure to talk to your doctor before you start. Also, if your activity causes you pain or other problems, be sure to let your doctor or nurse know about it.

Supportive Care for Lymphoma

Non-Hodgkin lymphoma and its treatment can lead to other health problems. You may receive supportive care to prevent or control these problems and to improve your comfort and quality of life during treatment.
You may receive antibiotics and other drugs to help protect you from infections. Your health care team may advise you to stay away from crowds and from people with colds and other contagious diseases. If an infection develops, it can be serious, and you will need treatment right away.
Non-Hodgkin lymphoma and its treatment also can lead to anemia, which may make you feel very tired. Drugs or blood transfusions can help with this problem. Refer to our reference list!

May opt-in for a Second Opinion

Before starting treatment, you might want a second opinion about your diagnosis and your treatment plan. Many insurance companies cover a second opinion if you or your doctor requests it.
It may take some time and effort to gather your medical records and see another doctor. In most cases, a brief delay in starting treatment will not make treatment less effective. To make sure, you should discuss this delay with your doctor. Sometimes people with non-Hodgkin lymphoma need treatment right away.
There are many ways to find a doctor for a second opinion. You can ask your doctor, a local or state medical society, a nearby hospital, or a medical school for names of specialists.
Nonprofit groups with an interest in lymphoma may be of help. You may want to see NCI's list of organizations that offer support services.

Questions before having a Stem Cell Transplant:

• What are the possible benefits and risks of different types of transplants?
• What kind of stem cell transplant will I have? If I need a donor, how will we find one?
• How long will I need to be in the hospital? Will I need special care? How will I be protected from germs?
• How will we know if the treatment is working?
• What can we do about side effects?
• How will treatment affect my normal activities?
• What is my chance of a full recovery?

Types of Stem Cell Transplantation

If lymphoma returns after treatment, you may receive stem cell transplantation. A transplant of your own blood-forming stem cells allows you to receive high doses of chemotherapy, radiation therapy, or both. The high doses destroy both lymphoma cells and healthy blood cells in the bone marrow.
Stem cell transplants take place in the hospital. After you receive high-dose treatment, healthy blood-forming stem cells are given to you through a flexible tube placed in a large vein in your neck or chest area. New blood cells develop from the transplanted stem cells.
The stem cells may come from your own body or from a donor:

• Autologous stem cell transplantation: This type of transplant uses your own stem cells. Your stem cells are removed before high-dose treatment. The cells may be treated to kill lymphoma cells that may be present. The stem cells are frozen and stored. After you receive high-dose treatment, the stored stem cells are thawed and returned to you.
• Allogeneic stem cell transplantation: Sometimes healthy stem cells from a donor are available. Your brother, sister, or parent may be the donor. Or the stem cells may come from an unrelated donor. Doctors use blood tests to be sure the donor's cells match your cells.
• Syngeneic stem cell transplantation: This type of transplant uses stem cells from a patient's healthy identical twin.
• Cord Blood stem cell transplantation: This type of transplant uses stem cells from umbilical cord or cords in children (dual cord for adults)

Questions to ask before having Radiation Therapy

• Why do I need this treatment?
• When will the treatments begin? When will they end?
• How will I feel during treatment?
• How will we know if the radiation treatment is working?
• Are there any lasting side effects?

Radiation Therapy for Lymphoma cells

Radiation therapy (also called radiotherapy) uses high-energy rays to kill lymphoma cells. It can shrink tumors and help control pain. Two types of radiation therapy are used for people with lymphoma:

• External radiation: A large machine aims the rays at the part of the body where lymphoma cells have collected. This is local therapy because it affects cells in the treated area only. Most people go to a hospital or clinic for treatment 5 days a week for several weeks.
• Systemic radiation: Some people with lymphoma receive an injection of radioactive material that travels throughout the body. The radioactive material is bound to monoclonal antibodies that seek out lymphoma cells. The radiation destroys the lymphoma cells.

The side effects of radiation therapy depend mainly on the type of radiation therapy, the dose of radiation, and the part of the body that is treated. For example, external radiation to your abdomen can cause nausea, vomiting, and diarrhea. When your chest and neck are treated, you may have a dry, sore throat and some trouble swallowing. In addition, your skin in the treated area may become red, dry, and tender. You also may lose your hair in the treated area.
You are likely to become very tired during external radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise people to try to stay as active as they can.
People who get systemic radiation also may feel very tired. They may be more likely to get infections.
If you have radiation therapy and chemotherapy at the same time, your side effects may be worse. The side effects can be distressing. You can talk with your doctor about ways to relieve them.

Biological Therapy for Non-Hodgkin Lymphoma

People with certain types of non-Hodgkin lymphoma may have biological therapy. This type of treatment helps the immune system fight cancer.
Monoclonal antibodies are the type of biological therapy used for lymphoma. They are proteins made in the lab that can bind to cancer cells. They help the immune system kill lymphoma cells. People receive this treatment through a vein at the doctor's office, clinic, or hospital.
Flu-like symptoms such as fever, chills, headache, weakness, and nausea may occur. Most side effects are easy to treat. Rarely, a person may have more serious side effects, such as breathing problems, low blood pressure, or severe skin rashes. Your doctor or nurse can tell you about the side effects that you can expect and how to manage them.

Questions to ask Before Chemo

You may want to ask your doctor these questions before having chemotherapy:

• Which drugs will I have? What are the expected benefits?
• When will treatment start? When will it end? How often will I have treatments?
• Where will I go for treatment? Will I be able to drive home afterward?
• What can I do to take care of myself during treatment?
• How will we know the treatment is working?
• What side effects should I tell you about? Can I prevent or treat any of these side effects?
• Will there be lasting side effects?

Chemotherapy for Lymphoma

Chemotherapy for lymphoma uses drugs to kill lymphoma cells. It is called systemic therapy because the drugs travel through the bloodstream. The drugs can reach lymphoma cells in almost all parts of the body. You may receive chemotherapy by mouth, through a vein, or in the space around the spinal cord. Treatment is usually in an outpatient part of the hospital, at the doctor's office, or at home. Some people need to stay in the hospital during treatment.
Chemotherapy is given in cycles. You have a treatment period followed by a rest period. The length of the rest period and the number of treatment cycles depend on the stage of your disease and on the anticancer drugs used.
If you have lymphoma in the stomach caused by H. pylori infection, your doctor may treat this lymphoma with antibiotics. After the drug cures the infection, the lymphoma also may go away.
The side effects depend mainly on which drugs are given and how much. The drugs can harm normal cells that divide rapidly:

• Blood cells: When chemotherapy lowers your levels of healthy blood cells, you are more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your health care team gives you blood tests to check for low levels of blood cells. If levels are low, there are medicines that can help your body make new blood cells.
• Cells in hair roots: Chemotherapy may cause hair loss. If you lose your hair, it will grow back, but it may be somewhat different in color and texture.
• Cells that line the digestive tract: Chemotherapy can cause poor appetite, nausea and vomiting, diarrhea, trouble swallowing, or mouth and lip sores. Ask your health care team about medicines or other treatments that help with these problems.

The drugs used for non-Hodgkin lymphoma also may cause skin rashes or blisters, and headaches or other aches. Your skin may become darker. Your nails may develop ridges or dark bands.
Your doctor can suggest ways to control many of these side effects.

Before going the Watchful Waiting route. questions to ask

You may want to ask your doctor these questions before choosing watchful waiting:

• If I choose watchful waiting, can I change my mind later on?
• Will the disease be harder to treat later?
• How often will I have checkups?
• Between checkups, what problems should I report?