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Lymphomas are a surprisingly diverse group of cancers that arise from cells of the immune system called lymphocytes, which are a type of white blood cell (Leukemia & Lymphoma Society 2011a). The American Cancer Society estimates that 79 030 new cases of lymphoma will be diagnosed in 2013 and 20 200 people will succumb to this disease (Siegel 2013).

Lymphomas can be broadly categorized as non-Hodgkin lymphoma (NHL) or Hodgkin lymphoma (HL). NHL comprises a diverse group of many different types of lymphoma, which together account for about 90% of all lymphoma cases. HL makes up about 10% of lymphoma cases (Leukemia & Lymphoma Society 2011a; Shankland 2012).

For NHL, chemotherapy and radiation therapy are the primary conventional treatment methods. Immunotherapy, which involves modifying the way the immune system responds to cancer cells, is also approved for some NHL subtypes (Leukemia & Lymphoma Society 2011a). HL has a high cure rate of about 75% overall and up to 90% in young patients. NHL prognosis varies significantly by subtype, with some variants having an excellent prognosis and other subtypes with more guarded long-term mortality estimates; inclusive of the many diverse subtypes of NHL, the average 5-year relative survival rate is about 71% (Leukemia & Lymphoma Society 2011b; Leukemia & Lymphoma Society 2013a).

The incidence of NHL has been increasing in the United States over the past few decades (Siegel 2012) for unclear reasons, though speculation includes impaired immune response to some types of viral infections (eg, with Epstein Barr virus [EBV], hepatitis B and C viruses) as well as enhanced exposure to industrial and/or environmental toxins including hair dyes, pesticides, and chemical solvents (De Falco 2011; Lim 2007; Olsson 1988; Ward 1996; Frankenfeld 2008). In contrast with NHL, the incidence of HL has remained relatively stable in the United States over the past few decades (Fast Stats [SEER] 2013).

An important aspect of lymphoma prevention involves the identification and treatment of infections known to be associated with lymphoma (Portlock 2008). For those undergoing active treatment, the use of readily available off-label drugs, including antiviral therapies, non-steroidal anti-inflammatory drugs (NSAIDs) (eg, diclofenac [Voltaren®]), and interleukin-6 (IL-6) inhibitors (eg, tocilizumab [Actemra®]) or integrative therapies such as mistletoe (eg, Iscador) may improve outcome (Gottfried 2013; Braun 2012; Wilson 2009; Wang 2009; Kovacs 2002; Kanakry 2013; Fields 2012). 

In this protocol you will learn the basics of lymphoma and the fundamentals of lymphoma care. The emerging, intriguing science in support of treating specific infections in lymphoma management will be discussed as well. Several integrative interventions that have been medically studied specifically in the context of lymphoma will be presented and the biological mechanisms by which they may reduce lymphoma progression will be reviewed.