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R IGH T- ON-TA R GE T T R E AT MEN T Patients with a certain type of slow-growing non- Hodgkin's lymphoma have a new, leading-edge treatment option at NYM: an injectable radioactive particle called yttrium-90. "The first line of defense against follicular and/or low-grade non- Hodgkin's lymphoma is typically close monitoring and treatment with chemotherapy or anti- cancer drugs," Dr. Ashamalla says. "However, if the patient's cancer recurs after the initial treatment, this new therapy can be added to help prevent it from spreading, thereby giving the patient a much better chance of a cure than previous options." Yttrium-90 delivers high doses of radiation to the cancer cells. The keenly targeted therapy allows patients to receive a higher treatment dose than they could with traditional, external forms of radiation. The treatment's precision allows it to spare nearby tissues and organs. monoclonal antibody therapy—as well as chemotherapy. These treatments may allow Rona to continue teaching students for years to come. TRACKING LYMPHOMA Lymphoma is a blood cancer that starts in the lymph nodes, which are present throughout the body. The cause is unknown, although immune system abnormalities can increase the risk for the disease. The first signs of lymphoma are often swelling lymph nodes and lumps, or nodules, which can be felt on the surface of the skin. Affected lymph nodes that are not close to the skin can interfere with nearby organs and cause other symptoms. Diseased lymph nodes that are near the lungs, for example, may lead to coughing and shortness of breath. Other lymphoma symptoms include fever, weight loss, and an enlarged liver or spleen. There are two main types of lymphoma: Hodgkin's lymphoma, which bears the name of Thomas Hodgkin, the 19th-century British doctor who—along with Dorothy Reed—first described this illness, and non-Hodgkin's lymphoma. Both develop in white blood cells, but they behave differently. Hodgkin's lymphoma has fewer subtypes and is more curable than non-Hodgkin's lymphoma—more than 75 percent of patients beat Hodgkin's lymphoma. Non-Hodgkin's lymphoma is more common, with more variable subtypes, including some that are curable and others that are not. LYMPHOMA DIAGNOSIS AND TREATMENT Doctors typically need a lymph node sample, which is obtained by excision of an abnormal node, to diagnose lymphoma. As with leukemia, the type and subtype of lymphoma determine treatment. Options include chemotherapy, targeted therapy, radiation therapy, stem cell transplant and, in some cases, careful monitoring without treatment—sometimes called watchful waiting. "For non-Hodgkin's lymphoma, the FDA [Food and Drug Administration] has approved a targeting medication aimed at a particular cell," says Hani Ashamalla, M.D., chair of radiation oncology at NYM. "When administered intravenously, it targets the lymphoma cells while avoiding the normal cells. Ibritumomab tiuxetan, also known as Zevalin ® , is a radio-pharmaceutical medication which carries a small dose of radioactive substance called yttrium-90 to where the lymphoma deposits. With few side effects, this medication may help extend periods of lymphoma remission." [See "Right-on-Target Treatment" for more about yttrium-90.] UNDERSTANDING MYELOMA Myeloma, like leukemia, begins in the bone marrow. It affects plasma cells—a type of white blood cell that makes antibodies to fight infection. Myeloma cells typically spread throughout M E E T T H E LY M P H N O D E S Lymph nodes are small structures that play an outsized role in maintaining good health. Hundreds of lymph nodes are scattered throughout the body as part of the lymphatic system, a network of vessels and structures that carry immune reactive cells through lymph fluid and bring foreign elements like infectious agents into contact with the immune system as fluid is filtered in lymph nodes and spleen. Some lymph nodes are located near the skin, including in the armpits and neck. Others reside deeper in the body, like near the bowel. After passing through the lymph nodes, what remains in the lymph fluid is free to merge into the blood. Swollen lymph nodes are uncomfortable, but they are also a sign that the glands are working properly to combat a foreign invader in the body. When the lymph nodes are fighting an infection, they swell. Usually, only one group of lymph nodes swells at a time. The swelling may occur in conjunction with other symptoms, including fever. If an individual develops blood cancer, lymph nodes may swell in multiple places on the body. thrive WIN T ER 2 017/ / W W W.N Y M.O RG 20 S P E C I A L R E P O R T