If you are living with other health conditions in addition to lymphoma, they may affect your cancer prognosis and which lymphoma treatment options are available to you.
Lymphomas are cancers of the lymphatic system, which is part of the circulatory and immune systems. Lymphoma occurs when white blood cells called lymphocytes grow out of control. There are two primary types of lymphoma — Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL).
Understanding the relationship between lymphoma and other health conditions can help you talk to your doctor about treatment and lifestyle changes. Better management of related conditions may improve your quality of life, prolong survival, and lower the risk for life-threatening complications.
When a person has more than one health condition at the same time, the conditions are known as comorbidities. When an additional medical condition makes lymphoma, or another illness, harder to treat, it is known as a complication. Having a comorbidity can complicate lymphoma treatment and add to the challenges of cancer.
Age can increase the likelihood of developing a comorbidity. Older adults are more likely to have multiple chronic conditions. A study from the Netherlands involving 904 people with NHL and 194 people with HL found a relationship between older age groups and comorbidity. Among people with NHL over 70, 61 percent had a serious comorbid condition. For those with HL, 56 percent of those over age 60 had a serious comorbid disease.
Some types of lymphoma, such as diffuse large B-cell lymphoma (DLBCL) and mantle cell lymphoma, are more common in older people.
Many studies use the Charlson Comorbidity Index (CCI) to measure a person’s comorbidities. The CCI predicts 10-year survival by considering age and the presence of various health conditions — including heart failure, chronic obstructive pulmonary disease (COPD), diabetes mellitus, and liver disease. A person’s score is determined by points assigned to their age and any comorbidities they may have. A higher score indicates a greater number of comorbid conditions.
Having health conditions in addition to lymphoma can impact your care team’s treatment decisions and affect which therapies are available to you. A systematic review in Expert Review of Hematology found that some people with DLBCL and high comorbidity scores were given lower doses of chemotherapy drugs. The review also found that in some cases, older people with comorbidities were not given R-CHOP — a chemotherapy regimen frequently used to treat DLBCL. R-CHOP combines chemotherapy drugs with the targeted therapy drug Rituxan (rituximab). Lower doses of chemotherapy drugs and alternate treatments were adopted to minimize side effects and to reduce the risk of complication for people with additional health concerns.
The presence of additional medical conditions may also make a person a poor candidate for a stem cell transplant. Stem cell transplantation requires the use of high-dose chemotherapy that may be difficult for an older person or someone with other health issues to tolerate. Allogeneic stem cell transplants (transplant using donor cells) can be especially difficult because of significant side effects, which may impact someone with comorbidities more intensely.
Comorbidities may also influence your prognosis. A retrospective study of 181 people with DLBCL found that complete remission rates were higher among people with a score of 0 to 1 on the Charlson Comorbidity Index compared to a score of 2 or greater — 77 percent compared to 50 percent. The study also found that the three-year overall survival rate was higher among those with fewer comorbid conditions.
While the impact of comorbidities on disease outlook is concerning, it’s important to remember that every individual’s prognosis is dependent on their specific health factors. Additionally, the systematic review previously discussed notes that more research is needed to fully understand the relationships between comorbid conditions and prognosis.
A British study of comorbidities and cancer found that approximately 30 percent of 7,420 people with HL had at least one comorbidity. Nearly 13 percent of the people with HL in the study had two or more comorbidities. According to the same study, the most commonly occurring comorbid conditions in HL include:
More than half of people with NHL have a comorbid condition at the time of diagnosis. The Dutch study of 904 people with non-Hodgkin lymphoma found the following comorbidities were most prevalent in people with NHL:
HIV infection can increase the likelihood of developing lymphoma. Compared to someone without HIV, an HIV-positive individual is 10 to 20 times more likely to develop NHL and eight times more likely to develop HL. The risk of a person with HIV developing lymphoma has decreased dramatically since the peak of the AIDS epidemic, thanks to the development of better treatments for HIV.
Nearly all HIV-related lymphomas are types of non-Hodgkin lymphoma. The following are types of NHL that commonly occur in people with HIV.
Burkitt’s lymphoma accounts for approximately 45 percent of lymphoma cases in people with HIV. Burkitt’s lymphoma is considered an AIDS-defining cancer. In other words, if you have HIV and are then diagnosed with Burkitt’s lymphoma, you are considered to have AIDS — the disease caused by HIV.
DLBCL accounts for about 35 percent of lymphomas related to HIV infection. Two rare subtypes of DLBCL are commonly associated with HIV: primary central nervous system lymphoma and plasmablastic lymphoma. DLBCL is an AIDS-defining cancer.
Primary effusion lymphoma is a very rare type of NHL that most commonly affects younger people with HIV. Primary effusion lymphoma accounts for just 2 percent to 4 percent of HIV-related lymphomas.
HIV-related lymphomas can be treated, and treatments are generally as effective in HIV-positive people as in HIV-negative people. In some cases, your lymphoma treatment may look slightly different. For example, lower doses of cancer drugs may be used because of the impact of HIV on the immune system. You may also need additional treatments to prevent infections.
Lymphoma treatments can cause long-term and delayed effects, beginning months or years after treatment is complete. These long-term or late effects are known as sequelae. Sequelae are conditions that follow after another disease or injury.
Some common sequelae after treatment for blood cancer include:
Not everyone treated for lymphoma develops sequelae. A person’s risk for developing sequelae after treatment is influenced by the type of lymphoma treatment they received, their age, and other individual health factors.
Your doctor can help you understand your individual risk factors for developing related conditions and recommend steps to manage or lower your risk. Always make sure your health care provider is aware of every medication you are taking for every condition, whether it is available over the counter or by prescription, including any vitamins or herbal supplements. Some medications can cause dangerous interactions. Open communication with your doctor ensures you can be partners in decision-making about your health.
Lymphoma Condition Guide