Hodgkin lymphoma (HL) is a pathologically and clinically heterogeneous hematologic malignancy. In the United States, an estimated 185,000 people are currently living with this disease, and it accounted for more than 9,000 new cases of cancer in 2015. Chemotherapy and radiation provide long-term benefit to the majority of patients with HL; however, some patients will eventually relapse.
Hematopoietic cell transplantation has become a cornerstone in the management of patients with lymphoma. The use of autologous transplant in Hodgkin’s and non-Hodgkin’s lymphoma has significantly improved the survivals of patients with relapsed disease.
Pre-transplant conditioning can significantly influence post-transplant outcomes. A strong anti-tumor effect achieved by myeloablative conditioning (MAC) is frequently counterbalanced by higher morbidity and non-relapse mortality, particularly in older adults. On the other hand, reduced intensity conditioning (RIC) is associated with lower post-transplant mortality, but may not be sufficient enough to prevent relapse, particularly in patients with persistent and aggressive malignances.
According to the American Cancer Society, it was estimated in 2011 there were 44,600 cases of leukemia, 66,360 cases of non-Hodgkin lymphoma, 8,830 cases of Hodgkin lymphoma, and 20,520 cases of myeloma diagnosed for the first time. In addition, the Leukemia and Lymphoma Society estimates that one person is diagnosed with a blood cancer approximately every four minutes in the U.S. The outcome for patients with hematologic malignancies has dramatically changed with the use of novel therapies.
The management of mantle cell lymphoma and T-cell lymphoma remains a challenge for many oncologists. Unlike the more common follicular or diffuse-large B-cell lymphomas, there is a paucity of prospective controlled trials, and there are no standards for the management of these diseases. Practice patterns can vary considerably from center to center.
Heterogeneous in nature the management of leukemia, lymphoma and multiple myeloma all present complex clinical problems, requiring an ever evolving multidisciplinary approach to diagnosis and treatment. Recognizing that patient quality of life and survival are significantly improved when these cancers are detected early and treated appropriately.