Businessman Sheldon Adelson Has Non-Hodgkin Lymphoma — Here’s What You Need To Know About The Disease

Unlike leukemia, which is a disease that results from too many white blood cells, lymphomas are white blood cell cancers that form tumors in the lymphatic system. “Quiet literally, lymph is lymphatic system -phoma means tumors, so lymphoma is white blood cell cancer that forms tumors in the lymphatic system,” says Dr. Peter Martin at Weill Cornell Medicine and New York Presbyterian. “This is opposed to leukemia, which is too many white blood cells, typically in the bone marrow or blood stream. Lymphomas, specifically are white blood cell cancers that form tumors in the lymphatic system.”

Within lymphoma, there are hodgkin and non-hodgkin cases. “Hodgkin lymphoma is simply a white blood cell cancer that has a very specific sub-type of white blood cells seen in those tumors called Reed-Sternburg cells or Hodgkin’s lymphoma cells. Then there’s everything else, non-Hodgkin’s lymphomas are the lymphomas that don’t have those Hodgkin’s lymphoma cells.”

Non-Hodgkin lymphoma is actually a collection of different lymphoma diseases, according to Dr. Catherine Diefenbach, Director of Translational Hematology and Clinical Lymphoma at NYU Langone Health and the Perlmutter Cancer Center. “Non-Hodgkin lymphoma is not one disease, it’s many diseases,” says Dr. Diefenbach. “And there are over 68 kinds of lymphoma. For this reason, it’s very important that if you have a diagnosis of lymphoma, you’re treated by a lymphoma specialist. And, we hope for all of our lymphoma patients that the first therapy you receive, will be your last therapy. That is, that we can treat you and cure you with first-line therapy.”

There are two main categories of lymphomas, and the category determines whether the cancer is curable or manageable, and whether treatment is necessary. “To understand and answer the question of what to do when your lymphoma comes back, you need to understand that in general, non-Hodgkin lymphomas are divided into aggressive or indolent lymphomas,” says Dr. Diefenbach. “And the approach to these lymphomas is very different. Aggressive lymphomas are treatable and potentially curable. Indolent lymphomas are managed and don’t always require treatment, however they are not curable by conventional means of describing curability.”

A lot of patients enter a total remission after treatment for aggressive lymphoma, but some will also relapse back into the disease. “Aggressive lymphomas are treated with chemotherapy up front, and that’s generally four or five drug combinations,” says Dr. Diefenbach. “After these multi-agent chemotherapy regimens, approximately 50 to 70% of patients will obtain a complete remission and stay in remission. However, between 30 and 50% of patients with aggressive lymphoma will relapse, and will require at least a second line of therapy.”

But for indolent lymphoma patients, there are a few other factors that go into the decision to treat the cancer. When they are treated, they often don’t relapse for a very long time. “For patients with indolent lymphoma, we really decide whether they need treatment based on whether they have bulky disease, their diseases transforms from indolent to aggressive, whether they have compromise of vital organ structures, or whether they have bulky nodes that are cosmetically or otherwise interfering with their quality of life,” says Dr. Diefenbach. “For these patients when we treat them, they often have an excellent response to therapy, but after time, sometimes decades of time, their lymphomas do come back.”

According to Dr. Diefenbach, non-hodgkin lymphoma is a cancer with symptoms that aren’t very specific to lymphoma. “Non-hodgkin’s lymphoma has a really non-specific symptom profile. Many patients… are diagnosed incidentally when they go to the doctor and they’re noticed to have a lump, or if they have a car accident and they have the scan and it shows some lymphadenopathy, or if they have another problem that they’re being worked up for.”

She also talks about being asked how long certain patients have had their indolent lymphoma inside them. “I tell them ‘it could be years, and it could be decades because when your lymphoma is living with you and you’re living with it, and it’s lazy lymphoma, you may not know you have it,'” she said.

“Patients with aggressive lymphoma are sick,” says Dr. Diefenbach. “These are very non-specific symptoms. They may have swollen lymph nodes that don’t go down, fevers, night sweats, itching, pain, bony pain, weight loss, but, again, there’s no specific constellation of symptoms that tells you lymphoma. Patients who feel ill and have swollen lymph nodes should certainly see their doctor and be worked up for lymphoma, but there are many other medical conditions that can mimic lymphoma. So, unless you have a tissue diagnosis that confirms lymphoma, you should not receive anti-lymphoma therapy.”

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