Blood Cancer (Malignant Hematology)

Review blood cancer and hematology information, including leukemia, multiple myeloma, lymphoma, benign hematology services, clinical trials, and advanced cellular therapy options available through Virginia Cancer Specialists.

Disease Information

Use the sections below to review diagnosis, staging, and treatment information for each condition in one place.

Leukemia

Leukemia

What is leukemia?

Leukemia is a cancer of the bone marrow and blood and is classified into five main groups according to cell type and rate of growth. Types of leukemia include acute lymphocytic leukemia (ALL), acute myeloid leukemia (AML), chronic lymphocytic leukemia (CLL) chronic myeloid leukemia (CML), and chronic myelomonocytic leukemia (CMML)

Leukemia is either chronic (which usually gets worse slowly) or acute (which usually gets worse quickly):

Chronic leukemia: Early in the disease, the leukemia cells can still do some of the work of normal white blood cells. People may not have any symptoms at first. Doctors often find chronic leukemia during a routine checkup – before there are any symptoms. Slowly, chronic leukemia gets worse. As the number of leukemia cells in the blood increases, people get symptoms, such as swollen lymph nodes or infections. When symptoms do appear, they are usually mild at first and get worse gradually.
Acute leukemia: The leukemia cells can't do any of the work of normal white blood cells. The number of leukemia cells increases rapidly. Acute leukemia usually worsens quickly.

What are the risk factors of leukemia?

Some of the risk factors for leukemia include:

Radiation exposure – Exposure to ionizing radiation increases the risk.
Family history – There is an increased risk for certain types of leukemia when immediate family members have the disease.
Age – The risk for leukemia increases with age.
Chemical exposure – Exposure to certain chemicals, pesticides, and chemotherapy drugs.
Gender – Leukemia is slightly more common in men.

What are the symptoms of leukemia?

Many signs and symptoms of leukemia have other causes that are often benign. Experiencing one or more of these symptoms doesn’t mean you have leukemia. However, if you have persistent signs or symptoms, please make an appointment with your doctor to address your concerns.

Excessive sweating: While sweating is normal, night sweats that drench your clothing or bed sheets may be cause for concern. If sweating wakes you up or is accompanied by other symptoms, see a physician.
Fatigue: While feeling tired on occasion is normal and can have many causes, fatigue refers to feeling exhausted without cause, especially over a prolonged period. Fatigue and weakness that do not go away with rest could be a sign of leukemia.
Unintentional weight loss: Losing a significant amount of weight in a short period of time unintentionally or without an obvious cause may be a sign of leukemia. If you lose more than 5% of your body weight without cause in 6to 12 months, see a physician.
Swollen lymph nodes: Swollen lymph nodes caused by leukemia are painless and found most commonly in the neck and armpits.
Enlarged liver or spleen: This is most commonly caused by chronic lymphocytic leukemia and chronic myelogenous leukemia, but it can occur in other types.
Bleeding easily, bruising, or red spots on skin: Leukemia can cause you to bleed and bruise more easily due to low levels of platelets, which are cells that form blood clots. Leukemia may also cause petechiae, which are small red spots on the skin from broken capillaries.
Infections: Bacterial or viral infections may be caught more easily and may take longer to recover from.
Fever or chills: Fever or chills caused by leukemia may seem similar to flu symptoms but will generally last longer than two weeks. They are also often accompanied by other symptoms.

Screening for Leukemia

If you have signs or symptoms that may point to leukemia, your physician may run a series of tests to confirm your diagnosis. This may include:

A physical exam to look for signs of anemia, swollen lymph nodes, or an enlarged liver or spleen.
Blood tests to check for abnormal levels of red or white blood cells or the presence of leukemia cells.
A bone marrow test to look for leukemia cells.

Receiving a leukemia diagnosis can be overwhelming. You may be feeling stress and anxiety over what comes next. Our team at Virginia Cancer Specialists is here to support you and provide you with the information you need to find the right path for your treatment.

How is leukemia staged?

After you are diagnosed with leukemia, your physician will determine the stage of your cancer to help guide your treatment plan. For most solid tumor cancers, staging is determined by the size of the tumor and how it has spread in the body. Since leukemia is a blood cancer and does not cause tumors to form, the stage of your cancer is described by the amount of cancerous white blood cells in the body and the accumulation of these cells in other organs.

When staging your leukemia, your physician may consider your white blood cell count, age, and health history, as well as any chromosome abnormalities, bone damage, or enlargement of your liver or spleen. Each type of leukemia affects the body differently and has its own

staging system.

Acute Lymphocytic Leukemia (ALL)

Acute lymphocytic leukemia is categorized by your white blood cell count at the time of your diagnosis and describes the response of your cancer to treatment.

Untreated: This describes a new diagnosis of ALL before you begin receiving treatment.
Remission: This occurs after treatment. Patients in remission have five percent or less cancerous bone marrow cells, white blood cell counts in a normal range, and are no longer experiencing symptoms. Patients are considered in complete molecular remission when there is no remaining evidence of cancer. Patients with minimal residual disease still have some evidence of cancer in their bone marrow and may be monitored more closely for signs they are no longer in remission.
Recurrent: Leukemia that has come back after treatment is considered recurrent. Patients will need more testing and treatment at this stage.

Chronic Lymphocytic Leukemia (CLL)

There are two staging systems that are commonly used to stage chronic lymphocytic leukemia:

Rai Staging System

Low risk/Stage 0: Patients have an abnormal increase in lymphocytes in their blood and bone marrow.
Intermediate risk/Stages I and II: In addition to an abnormal increase in lymphocytes, patients have either enlarged lymph nodes or an enlarged spleen and/or liver.
High risk/Stages III and IV: In addition to an abnormal increase in lymphocytes, patients have a decreased number of red blood cells (anemia) or a decreased number of platelets (thrombocytopenia).

Binet Staging System

A Stage: Patients have less than three areas of enlarged lymph tissue and do not have anemia or thrombocytopenia.
B Stage: Patients have more than three areas of enlarged lymph tissue and do not have anemia or thrombocytopenia.
C Stage: Patients have any number of areas of enlarged lymph tissue, as well as anemia and/or thrombocytopenia.

Acute Myeloid Leukemia (AML)

Like ALL, there is no standard staging system for acute myeloid leukemia, and the cancer is described by its response to treatment.

Untreated: AML is newly diagnosed. Patients have an abnormal blood cell count, at least 20 percent of the cells in their bone marrow are leukemia cells, and they have signs or symptoms of leukemia.
Remission: AML has been treated and patients have a normal blood cell count with less than 5 percent of leukemia cells in the bone marrow. Patients show no signs or symptoms of leukemia.
Refractory: This describes AML that does not go into remission after treatment.
Recurrent: AML has reappeared in the blood or bone marrow after remission.

Chronic Myeloid Leukemia (CML)

Physicians divide chronic myeloid leukemia into three phases based on the number of leukemia cells in the blood or bone marrow.

Chronic phase: Most patients are diagnosed at this stage. Less than 10 percent of the cells in the blood or bone marrow are leukemia cells. Patients usually experience mild symptoms, like fatigue.
Accelerated phase: Between 10 and 19 percent of cells in the bone marrow and blood are leukemia cells. Patients usually experience more symptoms, including fever, poor appetite, and weight loss.
Blastic phase: More than 20 percent of cells in the bone marrow and blood are leukemia cells, and these cells have spread throughout the body. Patients may experience fever, poor appetite, and weight loss.

Chronic Myelomonocytic Leukemia (CML)

Chronic Myelomonocytic Leukemia is divided into two groups describing leukemia cell counts in the blood and bone marrow.

CMML-1: Cancerous cells are less than five percent of white blood cells and less than 10 percent of bone marrow cells.
CMML-2: Cancerous cells are between five and 20 percent of white blood cells or between 10 and 20 percent of bone marrow cells.

Who will treat my leukemia?

You may have received a diagnosis from your primary care physician after noticing symptoms. For your leukemia treatment, you will see a medical oncologist and hematologist. This is a physician who specializes in cancer care and blood diseases.

Your treatment plan will vary depending on your individual needs, but in addition to your oncologist and hematologist, your cancer care team may include a radiation oncologist or bone marrow transplant specialist. Your care team may also include other clinical professionals, such as oncology nurses, social workers, pharmacists, genetic counselors, and dietitians. These clinicians all work together to develop the treatment path that’s right for you.

How is leukemia treated?

There are several types of leukemia, which are classified by the type of cell the cancer starts in and how fast the cancer is growing. The type of leukemia you have will help your care team determine the best treatment for you.

Below you’ll find the typical treatments for the main subtypes of leukemia. While these are the most commonly used treatments for each leukemia type, your physician will recommend the treatment that best fits your health needs and goals.

Acute Lymphocytic Leukemia (ALL)

Chemotherapy is the main treatment used for most people diagnosed with ALL. Chemotherapy uses drugs that travel through the bloodstream to target cancer cells throughout the body. Treatment usually takes place in three phases:

Induction: This is a short and intensive treatment period taking place over a month.
Consolidation: This is an intensive treatment period that usually lasts for a few months.
Maintenance: This is a less intensive treatment that usually takes place over two years.

Each treatment phase is followed by a period of rest to allow your body time to recover.

In some cases, your physician may recommend targeted therapy or immunotherapy drugs, or a stem cell transplant.

Chronic Lymphocytic Leukemia (CLL)

Treatment options for CLL can vary. Cancer fighting drugs are often used as an initial treatment for this type of leukemia. This may include:

Monoclonal antibodies: These are synthetic versions of immune system proteins that latch onto specific substances on the surface of leukemia cells.
Targeted drugs: These drugs work on targets within the cancer cells to stop growth.
Chemotherapy: This treatment kills cancer cells by stopping the cell life cycle. It is less specific than monoclonal antibodies or targeted drugs.
Surgery is rarely used to treat CLL, but your provider may recommend it if your spleen is enlarged.

Acute Myeloid Leukemia (AML)

Chemotherapy is the main treatment used to treat AML. Chemotherapy for this type of leukemia is usually given in two phases:

Induction: This is an intensive treatment that usually lasts about a week. This goal of this phase is to eliminate leukemia cells in the blood and reduce the number of leukemia cells in the bone marrow.
Consolidation: After a period of rest following the induction stage, chemotherapy is given in cycles to destroy the remaining leukemia cells.

For some patients, a third phase (maintenance) may use low doses of chemotherapy over the course of months or years. This is done to prevent leukemia from returning.

Chronic Myeloid Leukemia (CML)

Targeted therapies with drugs known as tyrosine kinase inhibitors (TKIs) are the standard treatment for CML. These cancer cells contain an abnormal gene that produces a protein which leads to uncontrolled cell growth and division. TKIs target this specific protein to stop growth.

If initial treatment with TKIs does not stop the cancer growth, your physician may increase the dose of the drug or switch to another type of TKI. Chemotherapy or a stem cell transplant may be an option for some patients.

Chronic Myelomonocytic Leukemia (CMML)

Stem cell transplants are the only curative treatment for CMML. The patient will receive high-dose chemotherapy, often along with radiation therapy to the entire body, to destroy the cells in the bone marrow. This is followed by the stem cell transplant, which gives the patient new, healthy blood-forming cells.

If a stem cell transplant cannot be done, supportive care like transfusions and antibiotics to treat infections can be used to relieve symptoms, limit complications, and reduce side effects.

What questions should I ask my leukemia care team?

At your first appointment, ask any questions you feel will better help you understand your situation and your options. You may want to come with a family member or friend. We also recommend writing down any questions you have prior to your appointment and bringing something to take notes with.

Here are a few questions that may help you gain a better understanding of your options:

What are the goals of each treatment for my type and stage of leukemia?
What are the risks or side effects of each treatment option?
Will I be able to work or participate in my daily activities while receiving treatment?
Will I need a bone marrow transplant?

Prevention of Leukemia

While in many cases there is no clear cause for leukemia, you can still practice some prevention activities.

Avoid cancer causing chemicals like benzene.
Quit smoking. Lighting up is a risk factor for many cancers including ALL.
Avoid radiation exposure! When possible, limit radiation exposure.

Multiple Myeloma

Multiple Myeloma

What is multiple myeloma?

Myeloma, or Kahler’s disease, is a cancer of the plasma cells. It develops in the bone marrow and is marked by an overgrowth of malignant plasma cells and excess production of an abnormal antibody known as M protein. As these cancerous multiple myeloma cells grow, they outnumber and crowd out healthy platelets, red blood cells, and white blood cells. This can weaken the immune system.

Myeloma is often called multiple myeloma (MM) because at least 90% of patients have more than one bone lesion at diagnosis or throughout their illness. Areas typically affected include the spine, skull, pelvis, and ribs.

There are two main myeloma groups:

Active myeloma: Also known as symptomatic myeloma, which can present with any of the following signs and symptoms:

Anemia
Areas of damaged bone (osteolytic lesions) that can be seen in an X-ray
Bone fractures
Bone or soft tissue tumor(s) containing myeloma cells
Presence of M protein in urine or blood
Hypercalcemia (high calcium level in the blood)
Kidney complications

Smoldering myeloma: A slow-growing, precancerous myeloma marked by an increased number of plasma cells and M protein but without symptoms. Once detected, patients are closely monitored for progression, but no treatment is immediately given. About 50% of patients diagnosed with this condition will develop active myeloma within five years.

Myeloma Types

Heavy Chain Myeloma: Heavy chain myeloma impacts the large subunit of the antibody structure and is classified by the type of abnormal antibodies, or immunoglobulins, produced. There are five main immunoglobulin types: G, A, M, E, or D.

Typically, only one type of immunoglobulin is overproduced in myeloma.

IgG is the most common, impacting approximately 60 – 70% of patients.
IgA affects approximately 20% of patients.
IgM, IgE, and IgD are rare.

Light Chain (Bence Jones) Myeloma: The body only produces the light chain component of the immunoglobulin. It is usually more aggressive than heavy chain myeloma. It affects approximately 15% of myeloma patients. Symptoms can include weakness, bone pain, and kidney dysfunction, though not all patients will have symptoms at diagnosis.

Non-Secretory Myeloma: A rare myeloma diagnosed in 1 – 5% of patients. Because M proteins are produced in small amounts or not at all, a specific test to measure kappa and lambda free light chains is used to monitor the disease.

What are the symptoms of multiple myeloma?

Multiple myeloma may initially go undetected, but the following are some common signs and symptoms:

Anemia, which may be the result of myeloma cells crowding out healthy red blood cells
Bone pain, typically in the back and ribs, but possible in any part of the body
Bones that fracture easily
Hypercalcemia, a high calcium level in the blood, due to bone breakdown, which can cause fatigue and kidney damage
An increase in upper respiratory and lung infections
Frequent nose bleeds, bleeding gums, bruising more easily, and cloudy vision resulting from a low platelet count
Numbness, weakness, or pain due to collapsed vertebrae or a pinched spinal nerve that is not the result of blunt trauma
Excessive and lingering exhaustion
Frequent and unexplained fevers
Weight loss, excessive thirst, nausea, or mental confusion that can be related to kidney damage or other imbalances

Individual symptoms may not be enough to indicate multiple myeloma, but any atypical experiences that continue for more than a few days should be discussed with your doctor.

How is myeloma staged?

Once a multiple myeloma diagnosis is confirmed, doctors will use the Revised International Staging System (RISS) to determine how advanced it is. Four factors are considered when assessing the stage of the disease:

Albumin level. Albumin is a protein produced in the liver and, at a healthy level, prevents fluids from leaking out of the blood vessels into other tissues.
Beta-2 microglobulin level. B2M is a protein found on the surface of cells. High levels can be an indication of blood and bone marrow cancers.
Assessment of the specific gene abnormalities (cytogenetics) of the cancer. Cytogenetic testing looks for chromosome changes. These chromosome changes can be categorized as not high risk, intermediate risk, or high risk.
LDH level. Lactate dehydrogenase (LDH) is an enzyme that helps the body produce energy. A high LDH level can indicate tissue damage and is considered an inflammatory marker.

There are three stage groups for multiple myeloma:

RISS Stage Group I

Albumin level is 3.5 (g/dL) or higher
Serum beta-2 microglobulin level is less than 3.5 (mg/L)
Chromosome changes are categorized as “not high risk”
LDH levels are normal

All factors must be present and at the specified range for a Stage Group I determination.

RISS Stage Group II

Criteria are beyond Stage Group I but do not meet Stage Group III standards.

RISS Stage Group III

Serum beta-2 microglobulin level is 5.5 (mg/L) or higher
Chromosome changes are categorized as “high risk”
And/or LDH levels are high

Staging helps your care team plan the best treatment for your diagnosis. If you have questions or need additional information, speak with your doctor about what treatment options are available to you.

How is multiple myeloma treated?

Your doctor will recommend a treatment plan that is best suited for your myeloma type, cancer stage, and other health factors. As you consider your options, it is important to understand what each treatment type entails.

Drug Therapies

Chemotherapy: Chemotherapy is a systemic treatment that travels throughout the body and kills cancer cells. Chemotherapy combines drugs that can be taken orally or intravenously, typically administered on a three to four-week cycle. One course of treatment can require four to six cycles. It is sometimes combined with other drugs, like steroids or immunomodulatory drugs.
Corticosteroids (Steroids): Steroids can be used at all stages of the disease. At high doses, steroids work to destroy multiple myeloma cells. They also decrease inflammation and can reduce nausea, a common chemotherapy side effect.
Proteasome inhibitors: These drugs are widely used for multiple myeloma and at all stages of the disease. Proteasomes are protein complexes that support cell survival and proliferation. Inhibitors block typical proteasome function, which causes cancer cells to die. Inhibitors can be administered orally or by infusion.
Nuclear export inhibitor: XPO1 protein regulates the transport of proteins and multiple RNA species. Inhibitors block XP01, which causes cancer cell death.

Immunotherapies

Immunotherapy is a type of drug therapy that triggers your immune system to fight cancer.

Immunomodulatory drugs (IMiDs): IMiDs are a class of immunotherapy drugs that stimulate the immune system, prevent cancer cell growth, and kill myeloma cells. They are orally taken.
Monoclonal Antibodies: This treatment uses genetically-engineered antibodies to target and attack the surface proteins of myeloma cells. Monoclonal antibodies kill cancer cells and support the body’s immune response to do the same. It is given intravenously.
Bispecific T-cell engager (BiTE): BITEs are engineered proteins injected into the body. These proteins bind the immune cells (T cells) to the BCMA protein on the myeloma cells, which prompts the immune system to attack.

CAR T-Cell Therapy

Chimeric Antigen Receptor T-cell (CAR T-cell) therapy is a type of immunotherapy that requires removal and genetic alteration of the patient’s T cells. Once these modified cells are infused back into the patient’s bloodstream, they seek and attack cancer cells.
BCMA-Targeting Drugs: BCMA is a surface protein found in nearly all cases of MM. In BCMA-targeted therapy, the patient’s T cells are collected and modified to recognize BCMA on the surface of the myeloma cells and to kill those cells.

CAR T-cell therapy can have serious side effects. Your health team may monitor your health for several weeks after treatment.

Stem Cell Transplant

Stem cell transplant replaces a patient’s damaged stem cells with healthy stem cells. A myeloma patient typically receives a high dose of chemotherapy to kill existing cancer cells before receiving new, healthy blood-forming stem cells. There are two types:
Autologous Transplants: The patient’s own stem cells are harvested and stored until ready for transplant. Some doctors may recommend a second autologous transplant six to 12 months later.
Allogenic Transplants: The patient receives stem cells from a donor, usually a close relative with a closely matched cell type. This type of transplant is riskier but may be more effective at fighting cancer.

Allogenic transplants are not considered a standard treatment. Autologous transplants are more common.

Radiation Therapy

External beam radiation may be used to relieve bone pain and prevent further bone damage. It is also a common treatment for solitary plasmacytomas (plasma cell tumors). Radiation relieves multiple myeloma symptoms rather than treating the disease itself.

Surgery

Surgery is not a standard treatment for multiple myeloma. It is sometimes used to remove solitary plasmacytomas and can help repair and support disease-weakened bones.

Speak with your doctor to understand each treatment’s risks and side effects and to help determine the best approach for you.

Lymphoma

What is lymphoma?

Lymphoma describes cancer that begins in the cells of the lymphatic system, which includes the organs that produce, store, and carry infection-fighting white blood cells. Cells called lymphocytes, a type of white blood cell, make up the lymphatic system and are where lymphoma starts. Lymphomas may begin in any lymph tissue including lymph nodes, spleen, bone marrow, thymus, adenoids and tonsils, and the digestive tract.

There are two main types of lymphoma: Hodgkin or non-Hodgkin. These two main types of lymphoma begin in different lymphocyte cells, which means they behave and respond to treatment differently.

Hodgkin lymphoma is a cancer that begins in cells of the immune system. The immune system fights infections and other diseases.Hodgkin lymphoma is characterized by the appearance of large, abnormal white blood cells called Reed- Sternberg cells. It can start at almost any part of the body, though it is most commonly found in the neck, chest, or underarms. This cancer spreads by moving from one group of lymph nodes to the next in an orderly fashion, which often allows the cancer to be diagnosed and treated at an earlier stage.

Non-Hodgkin lymphoma (NHL) is the more common type of lymphoma. The white blood cells affected by this type of lymphoma do not contain Reed-Sternberg cells. There are many subtypes of non-Hodgkin lymphoma, which are divided into two main categories: b-cell lymphomas and t-cell lymphomas. The exact type of non-Hodgkin lymphoma will determine the best course of treatment.

Non-Hodgkin lymphoma begins when a lymphocyte (usually a B cell) becomes abnormal. The abnormal cell divides to make copies of itself. The new cells divide again and again, making more and more abnormal cells. The abnormal cells don't die when they should. They don't protect the body from infections or other diseases. The buildup of extra cells often forms a mass of tissue called a growth or tumor. Because lymphatic tissue is in many parts of the body, Hodgkin lymphoma can start almost anywhere. Usually, it's first found in a lymph node. When lymphoma is found, the pathologist reports the type. There are many types of lymphoma. The most common types are diffuse large B-cell lymphoma and follicular lymphoma. Lymphomas may be grouped by how quickly they are likely to grow:

Indolent (also called low-grade) lymphomas grow slowly. They tend to cause few symptoms.
Aggressive (also called intermediate-grade and high-grade) lymphomas grow and spread more quickly. They tend to cause severe symptoms. Over time, many indolent lymphomas become aggressive lymphomas.

It's a good idea to get a second opinion about the type of lymphoma that you have. The treatment plan varies by the type of lymphoma.

What are the signs and symptoms of lymphoma?

Signs and symptoms of lymphoma can vary from person to person. Some of the most common signs or symptoms may include:

Swollen lymph nodes: Lumps found in the neck, armpit, or groin are the most common sign of lymphoma. These lumps are caused by swelling in the lymph nodes and are painless. Swollen lymph nodes have multiple causes, and some cysts or harmless growths may also look like swollen lymph nodes. If you notice a lump that doesn’t go away in a couple of weeks, or if the lump is getting bigger, see a physician.
Fatigue: While feeling tired on occasion is normal and can have many causes, fatigue refers to feeling exhausted without cause, especially over a prolonged period.
Unexplained weight loss: Losing a significant amount of weight in a short period of time without an obvious cause can be a sign of lymphoma. If you lose more than five percent of your body weight without cause in 6to 12 months, see a physician.
Infections: If you are contracting infections more easily and find them more difficult to get rid of, this may be caused by lymphoma.
Excessive sweating: Lymphoma may cause sweating, particularly at night. While sweating is normal, drenching your clothing or bed sheets may be cause for concern. If sweating wakes you up or is accompanied by other symptoms, see a physician.
Itching: Itching without a rash can be a sign of Hodgkin lymphoma. If itching persists for two or more weeks, see a physician.
Fever: Fevers caused by lymphoma are often accompanied by night sweats, weight loss, or infection. These fevers are usually just a little over your normal body temperature and can come and go.

Additional symptoms may occur depending on where the lymphoma is. These may include a swollen belly, feeling full quickly, chest pain or pressure, shortness of breath or a cough, or easy bruising or bleeding.

Many signs and symptoms of lymphoma have other causes and can often be benign. Experiencing one or more of these symptoms doesn’t mean you have lymphoma. However, if you have persistent health concerns, please speak to a physician.

How is lymphoma staged?

Stages of Lymphoma:

Stage I

Cancer in this stage has one of these two characteristics:

Lymphoma cells are in one lymph node region (including either one lymph node or one group of adjacent lymph nodes).
Lymphoma cells are in one part of one organ outside of the lymphatic system.

Stage II

Cancer in this stage has one of these two characteristics:

Lymphoma cells are found in two or more lymph node regions located on the same side of the diaphragm.
Lymphoma cells are found in a group of lymph nodes and one area of a nearby organ. Other lymph nodes on the same side of the diaphragm may also contain lymphoma cells.

Stage III

Cancer in this stage has one of these two characteristics:

Lymphoma cells are found in lymph nodes on both sides of the diaphragm.
Lymphoma cells are in lymph nodes above the diaphragm and in the spleen.

Stage IV

Cancer in this stage has spread to at least one organ outside of the lymphatic system.

Additional Descriptions of Lymphoma:

Your physician may also add a letter to the stage of your cancer, like stage IIB. This is used to further describe your cancer.

Category A: Patients in this category are not experiencing fever, weight loss, or night sweats.
Category B: Patients are experiencing fever, weight loss, or night sweats.
Category E: Lymphoma has developed outside of the lymph nodes.
Category S: Lymphoma is found in the spleen.

The term bulky disease may also be used to describe large tumors found in the chest.

How is lymphoma treated?

If you have been recently diagnosed with lymphoma, your cancer care team will help you develop a treatment plan that best fits your cancer and your overall goals for your health. The treatment your physician recommends may depend on the type of lymphoma you have and the stage your cancer is in. If you have any questions about your treatment options, always ask your doctor.

Chemotherapy

Chemotherapy is used to treat cancer by using anti-cancer drugs that are either given as an injection or taken by mouth. This is often an effective treatment for lymphoma because chemotherapy drugs enter through the blood stream and can reach the entire body.

Chemotherapy is the main treatment given for most Hodgkin and non-Hodgkin lymphomas. This treatment may be used alone, or with other treatments like immunotherapy or radiation therapy, depending on the type of cancer you have and its stage.

Immunotherapy

Immunotherapy leverages your immune system to fight cancer. Immunotherapy drugs are used to either boost your immune system to help it target and attack cancer cells or to change the way your immune system works to fight the cancer cells.

Monoclonal antibodies, which are man-made versions of the proteins made by your immune system to fight your infection, can be used to treat lymphoma. These drugs work by targeting a substance on the surface of lymphocytes, the cells where lymphoma starts.

Immune checkpoint inhibitors may also be used to treat lymphoma. Your immune system keeps itself from attacking normal cells in the body with “checkpoint” proteins, which determine whether an immune response is started. Cancer cells can use these checkpoints and avoid being targeted by the immune system. Immunotherapy drugs target these checkpoints to start an immune response.

Certain types of non-Hodgkin lymphoma may also be treated with drugs called bispecific antibodies, which attach to both cancer cells and immune system cells. This brings the two cells together, helping the immune system destroy the cancer cells.

Chimeric antigen receptor (CAR) T-cell therapy

Chimeric antigen receptor (CAR) T-cell therapy may be used for some non-Hodgkin lymphomas. This treatment removes immune cells called T-cells from the patient’s blood and alters them in a lab. The altered cells have receptors that attach to the proteins on the surface of lymphoma cells to destroy them.

Bone Marrow/Stem Cell Transplantation

Stem cell transplants can be used to treat lymphomas that have not responded to chemotherapy or radiation, or lymphoma that has come back after treatment. A stem cell transplant allows doctors to give a patient a higher dose of chemotherapy. Doses of chemotherapy drugs are usually limited to minimize damage to the bone marrow, where new blood cells are made. In this treatment, patients receive a high dose of chemotherapy, and the transplanted cells create healthy bone marrow.

Radiation Therapy for Lymphoma

Radiation therapy uses concentrated rays of high-energy to target and destroy cancer cells while minimizing the effect on healthy cells. If you have been diagnosed with lymphoma, your physician may recommend radiation therapy to eliminate your cancer or to control any symptoms you may be experiencing.

Radiation therapy may be used to treat classic Hodgkin lymphoma at an early stage, often after chemotherapy. It may also be used for cancers at an advanced stage that have not responded to chemotherapy. Radiation is sometimes used by itself to treat nodular lymphocyte-predominant Hodgkin lymphoma found at an early stage.

Radiation therapy can be used as the main treatment for some types of non-Hodgkin lymphoma. These cancers found at an early stage often respond well to radiation. If the cancer is found at a more advanced stage, radiation may be used along with chemotherapy.

If you are receiving a stem cell transplant, radiation may be used to treat the whole body along with chemotherapy to eliminate lymphoma cells before the transplant.

Radiation therapy is also used to treat symptoms caused by non-Hodgkin lymphoma that has spread to other organs, like the brain or spinal cord.

What can I expect from radiation therapy for lymphoma?

Lymphoma is usually treated with external beam radiation, which uses a machine to deliver carefully focused rays of energy from outside of the body. To treat lymphoma, your team will target the lymph nodes where your cancer started and any nearby areas where the cancer has spread.

Before your treatment, your radiation team will use imaging tests like CT or PET scans to determine where to aim the radiation while avoiding healthy tissue in nearby areas. Your team may use casts, body molds, or head rests to help you stay in the same position for each treatment. Radiation treatments are typically given five days a week over the course of several weeks. Treatment is painless, and only lasts a few minutes per session, though the setup may take longer.

Treatments

Review the treatment approaches your care team may consider, grouped by type.

Hematology

The Benign Hematology Clinic at Virginia Cancer Specialists

The Benign Hematology Clinic at Virginia Cancer Specialists

Virginia Cancer Specialists also provides comprehensive care for various benign hematologic conditions, with a dedicated Benign Hematology Clinic led by our experienced Advanced Practice Providers (APPs). Our Clinic APPs directly collaborate and hand-off to physicians when complex cases arise.

In our Benign Hematology Clinic, we welcome referrals for patients with multifactorial or refractory anemia (iron deficiency, B12/folate deficiency, anemia of chronic disease) and deep vein thrombosis (DVT)/pulmonary embolism (PE).

We also provide full-service diagnostic and infusion services support, such as:

On-site laboratory and pathology support
Bone marrow biopsy capability
Iron infusions
Anticoagulation management
Growth factor support

With coordinated, patient-centered care and timely access to advanced diagnostics and therapies, you can trust you will receive expert evaluation and compassionate management close to home.

Clinical trials are available through the Virginia Cancer Specialists Research Institute. Talk with your care team or call 703.636.1473 to ask about studies related to your diagnosis.

CAR T-Cell Therapy Program

At Virginia Cancer Specialists, we’re proud to bring one of the most advanced cancer treatments – CAR T-cell therapy – to our community. This groundbreaking, personalized immunotherapy is transforming outcomes for patients with certain blood cancers, offering new hope where traditional treatments may have failed. Also known as T-Cell immunotherapy, CAR T-Cell Therapy in Northern Virginia is available at select Virginia Cancer Specialists locations for eligible patients with lymphoma, leukemia, and multiple myeloma.

Chimeric antigen receptor (CAR) T-cell therapy is a highly personalized version of immunotherapy that has been developed and refined over the last decade, demonstrating unprecedented efficacy in certain forms of aggressive hematologic cancers. A patient’s own healthy immune cells (T cells) are collected, precisely reprogrammed to identify, target, and destroy cancer cells potentially yielding long term, treatment-free remissions. This advanced form of immunotherapy, sometimes referred to as T-Cell cancer treatment, is part of our commitment to providing cutting-edge care to patients throughout Northern Virginia.

CAR T-cell therapy is FDA-approved for certain types of relapsed or refractory blood cancers. Virginia Cancer Specialists is certified to administer lisocabtagene maraleucel for relapsed or refractory non-Hodgkin lymphoma (NHL) and idecabtagene vicleucel for relapsed or refractory multiple myeloma (MM). These groundbreaking therapies represent a major step forward in personalized cancer treatment, offering new hope to patients. It is anticipated that further cell therapy products will be added as treatment options in the future as well.

Learn more about the VCS CAR T-Cell Therapy Program.

Cancer Treatment Options

Most treatment plans combine several of these approaches. Your Virginia Cancer Specialists care team builds a plan around your specific diagnosis — explore each option below, or browse all treatments & services.

Chemotherapy

Chemotherapy uses powerful medicines to destroy cancer cells or slow their growth, and it remains one of the most widely used and effective cancer treatments. It can be given on its own or alongside surgery, radiation, or other therapies.

Given by IV infusion or as pills, in planned cycles with recovery time between
Delivered in our offices by our medical oncology team, close to home
Often used to shrink a tumor before surgery or lower the risk of recurrence after

Radiation Therapy

Radiation therapy uses precisely targeted, high-energy X-rays to destroy cancer cells while sparing nearby healthy tissue. Virginia Cancer Specialists offers advanced, state-of-the-art radiation for a wide range of cancers and select benign conditions.

Painless outpatient treatments that usually take only minutes a day
Planned and delivered with image guidance by our APEx-accredited radiation oncology team
Can be the main treatment, or support surgery and chemotherapy

Surgery to Treat Cancer

Surgery is one of the oldest and most effective treatments for cancer. For many cancers, removing the tumor offers the best chance for a positive outcome, often combined with other therapies before or after the operation.

Used to diagnose, stage, and treat cancer, and to relieve symptoms
Minimally invasive and robotic-assisted techniques when appropriate
Coordinated with your medical and radiation oncologists as one care plan

Immunotherapy

Immunotherapy helps your body’s own immune system recognize, target, and destroy cancer cells. Over the past decade it has transformed treatment for many types of cancer.

Works with your immune system rather than attacking cells directly
Usually given by IV infusion in our offices
May be used alone or with chemotherapy, radiation, or targeted therapy

Targeted Therapy

Targeted therapy focuses on the specific genes, proteins, and other molecular features that help cancer cells grow and survive. By attacking what makes a cancer unique, it can be highly effective with fewer effects on healthy cells.

Guided by biomarker and genomic testing of your cancer
Taken as pills or given by infusion
Often paired with chemotherapy, hormone therapy, or immunotherapy

Hormone Therapy

Hormone therapy treats cancers that use the body’s natural hormones to grow — most commonly breast and prostate cancers — by lowering hormone levels or blocking their effects.

Usually pills or injections rather than infusions
Can lower the risk of recurrence after surgery or radiation
Managed by your medical oncology team, sometimes over months or years

Specialized Programs

CAR T-Cell Therapy Program — one of the most advanced treatments for certain blood cancers: your own immune cells, re-engineered to fight the disease.

Scalp Cooling — cold-cap therapy that can significantly reduce hair loss during many types of chemotherapy.

Clinical Trials & Research — access to tomorrow’s treatments today through the Virginia Cancer Specialists Research Institute.

Physicians

Find physicians and care teams who support this specialty area.

Locations

Find Virginia Cancer Specialists locations connected to patient care across the region.

Alexandria

Hours of Operation
Monday through Friday 8:30a.m. to 4:30p.m.

Phone
571.350.8400

Fax
703.823.5723

Address
4660 Kenmore Ave., Suite 1018

Alexandria, VA 22304

Arlington

Hours of Operation
Monday through Friday 8:30 a.m. to 5:00 p.m.

Phone
571.350.8400

Fax
703.528.0338

Address
1100 N. Glebe Rd., Suite 1600, 3 Ballston Plaza

Arlington, VA 22201

Bristow

Hours of Operation
Monday through Friday 8:30 a.m. to 5:00 p.m.

Phone
571.350.8400

Fax
571.222.2202

Address
9450 Innovation Drive

Manassas, VA 20110

Fairfax

Hours of Operation
Monday through Friday 8:30 a.m. to 5:00 p.m

Phone
571.350.8400

Fax
703.280.9596

Address
8613 Route 29

Fairfax, VA 22031

Our Supportive Cancer Care Team

The Supportive Cancer Care Team works in close partnership with each patient’s primary oncology team to ensure patients receive coordinated, comprehensive, seamless support that complements their current medical treatment. Patients have easy access to a team of compassionate experts – palliative care physicians, pain management specialists, social workers, nutritionists, nurse navigators, clinical coordinators, research coordinators, financial counselors, and many others who provide guidance, education, and emotional support every step of the way.

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Goals of Supportive Cancer Care

Virginia Cancer Specialists’ Supportive Cancer Care Program has 3 key goals:

Hallmarks of Our Supportive Cancer Care Program

While the primary goal is to improve quality of life for the patient and family throughout the treatment process, there are various ways in which this can be accomplished:

Focusing on symptom management, including treating pain, insomnia, anxiety, respiratory and gastrointestinal problems
Fostering open and honest communication
Understanding the patient’s hopes and expectations
Facing the realities of treatment and how it affects one’s life, including finances, employment, and more
Providing support to caregivers and family