Non-Hodgkin’s lymphoma is defined as a cancer of the lymphocytes that are a type of white blood cells. White blood cells are a part of body’s immune system and hence the body’s defense mechanism is compromised. It starts when the body produces excess of abnormal lymphocytes. Normally the white blood cells go through a cycle where the old cells die and the body’s defense mechanism produces new ones to replace them. In non-Hodgkin’s lymphoma the old lymphocytes do not die, instead they continue to multiply uncontrollably forming immature white blood cells that are unable to fight infection.
Does Non-Hodgkin’s Lymphoma Come Back?
The treatment plan for lymphoma can be a rigorous one especially for an aggressive tumor. For most cases the lymphoma does not come back after treatment. But in few cases even after treatment the lymphoma comes back, which is known as recurrence. For these people regular treatments with chemotherapy, and radiotherapy is required from time to time to keep the non-Hodgkin’s lymphoma in check and relieve the symptoms. A regular follow up with the doctor is necessary as there are different types of non-Hodgkin’s lymphoma that require different treatments. Even after the treatment is done, a close watch is required to look for any recurring symptoms. Sometimes the side effects of treatment last for a very long time and might not show up until years, even after the treatment has finished. Therefore, it becomes necessary to visit the doctor to prevent any changes or problems that might occur late after therapy.
Exams And Tests For Recurrent Non-Hodgkin’s Lymphoma
During the follow up visits the doctor asks you about any symptoms that you might be suffering from post therapy. After that examination of lymph nodes is necessary to look for signs of infection and blood tests to ensure the normal range of white blood cells or lymphocytes. Imaging tests are done based on the type, location and stage of the lymphoma. CT scans or PET/CT scans are done to monitor the size of any remaining tumor that might still exist or any new tumors that might have developed.
Frequent blood tests may be required to look for possible signs of lymphoma recurrence. Blood counts can sometimes also show some abnormalities because of a bone disease known as myelodysplastic dysplasia that can lead to leukemia. It is also possible for a person to develop leukemia a few after being treated for non-hodgkin’s lymphoma.
Symptoms of Recurrent Non-Hodgkin’s Lymphoma
The symptoms vary from person to person and the common symptoms of non-Hodgkin’s lymphoma include unexplained fever, swelling in the lymph nodes of neck, armpits and groin region, night sweats with or without chills, persistent fatigue, lethargy or feeling of being tired all the time, loss of appetite, nausea and vomiting, weight loss that can’t be explained, pain in the abdomen or swelling or a feeling of fullness, dry or itchy skin (pruritis), cough with shortness of breath and pain in the chest.
Follow up visits with your oncologists are important to detect any relapsing cancer early. Most of the recurrences of non-Hodgkin’s lymphoma occur within two years of treatment. The recurrence for non-Hodgkin’s lymphoma vary from person to person depending upon the type, stage and patient’s age and general condition.
Treatment For Relapsed Non-Hodgkin’s Lymphoma
When the non-Hodgkin’s lymphoma returns the treatment is usually more intensive than the first course of treatment. A different type of chemotherapy is done along with stem cell transplantation if a person is fit enough. Newer drugs available are used to treat the lymphoma for relapsed and refractory lymphoma.
A variety of chemotherapy regimens can be used including gemcitabine or platinum drugs (cisplatin). GEM-P (gemcitabine, cisplatin and, methylprednisolone), ICE (ifosfamide, carboplatin and etoposide), DHAP (dexamethasone, high dose cytarabine and cisplatin, platinol) are all used as chemotherapy regimens.
When chemotherapy works then high dose of chemotherapy along with stem cell transplant is offered to give you the best chance of staying in remission. Higher doses of treatment work well but they can also cause damage to your bone marrow, so special care and supervision is required.
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