Aggressive or High Grade Lymphomas

  • What is high grade lymphoma?

High grade lymphomas are cancers arising from white cells in the lymph nodes. Since these cells proliferate rapidly, they are called high grade or aggressive.

  • How are they diagnosed?

They are usually diagnosed by biopsing a  lymph node. Lymphomas are the most difficult diseases to diagnose and sub classify unless in experienced hands. Because the sub classification requires various special stains, immuno chemistry and molecular markers, diagnosis can be complex sometimes. But as a patient you should remember that often one has to wait a little while, to get the correct diagnosis. The treating doctor will decide what special investigations are to be done in the lymph node or tissue biopsied.

  • How are they treated?

The treatment of these lymphomas is entirely different from low grade lymphomas. Here treatment is directed towards achieving a complete cure. Since these cancers grow rapidly, there is no point in leaving any residual disease back unlike low grade lymphomas.

  • What happens during chemotherapy?

You may experience some side effects such as hair fall, tiredness, loss of appetite during chemotherapy. Since side effects may vary with each drug, your doctor will brief about the drugs. However, the general thing is you can lead a normal life inbetween the courses, except that you

    May have to modify the diet so as to avoid indigestion, constipation etc. Bland diets, plenty of vegetables and fruits are helpful. Remember, you can take ice creams, yoghurt etc (which do not cause respiratory infections as commonly perceived) provided you are not a diabetic. You do not have to eat a normal diet. Losing some weight during therapy is of no concern.

    You may have to take more rest (or more sleep) than usual, but remember, that you have to keep yourself active in between and avoid being bed ridden

    you get any fever, or signs of infections such as severe cough, diarrohea you have to contact your doctor (and follow the precautions advised) immediately

  • How are they graded?

Mainly the aggressive lymphomas can be intermediate grade or high grade. Depending on the spread of lymphoma cells to various organs, age, performance status, proliferating capacity, these lymphomas are graded.

High grade lymphomas are treated similar to acute leukemias. The therapy will be prolonged and intensive as acute leukemias. As these disease has to be completely eradicated, they need aggressive management.

Intermdiate grade lymphomas are also treated to achieve a complete cure.

  • How do I know whether I am progressing well during treatment?

You will be monitored during treatment with scans and biochemical parameters. PET scans are useful to know the response much earlier in many of the Hodgkins and Non Hodgkins lymphomas.  PET scans tell us about disease activity. So,if they become negative we know that we are on top of the disease. On the other hand, if it is active, even if the disease has disappeared by normal scans you may require intensive treatment.

  • Whether these lymphomas are benefited by transplants?

Usually as a first line of therapy, they do not need transplants. However, in very few cases there may a ground to do autologous stem cell transplant upfront as well. But majority of them may need stem cell transplant if the disease comes back. Non-myeloablative allogenic transplants also have a role in intermediate grade lymphomas.

Department of Hemato oncology,

Amended on Dec 14th, 2014 @VNCC, GKNM by Dr Suthanthira kannan,

Amended on 2nd Nov, 2016 @ Coimbatore Kidney centre by Dr Suthanthira Kannan

 

 
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