Lymphoma

Clinical Manifestations
There are two main types of lymphomas, Non-Hodgkin’s or Hodgkin’s lymphoma.
● Non-Hodgkin’s lymphomas (NHL) is characterized as B-cell (90%) or T-cell lymphomas,
depending on the lymphoid cell of origin. The classification of NHL has more than 40
distinct subtypes. Lab values report elevated LDH and uric acid Patients often report
fever, weight loss, and night sweats upon diagnosis.
● Hodgkin's Lymphomas (HL) show the presence of Reed-Sternberg cells. There are 5
main types of HL:
● Nodular sclerosing
● Mixed cellularity
● Lymphocyte depletion
● Lymphocyte-rich (classical Hodgkin disease)
● Nodular lymphocyte-predominant

Both lymphomas and leukemias start in lymphocytes in the bone marrow. Lymphomas mainly
affect the lymph nodes and other organs, whereas leukemias affect the bone marrow and blood.

Leukemia
Clinical manifestations
There are several types of leukemia: Acute lymphocytic, Acute Myeloid, Chronic lymphocytic,
Chronic Myeloid.
● Acute Lymphocytic leukemia is a fast-growing type of leukemia that develops from early
immature forms of lymphocytes (WBC).
● Acute Myeloid leukemia is a fast growing type that develops in the bone marrow from
immature myeloid cells. Myeloid cells develop into RBC, other WBCs, or platelets. This
is the most common form in adults accounting for 80% of all leukemia cases.
● Chronic lymphocytic leukemia is a slow growing type that develops from more mature
WBCs or lymphocytes. These malfunctioning cells crowd out normal cells and can go
undetected until later in life.
● Chronic Myeloid leukemia is a slow growing type that develops in myeloid cells. An
abnormal gene called BCR-ABL creates malfunctioning cells. These cells divide and spill
over in the blood often settling in the spleen.

Nutrition Assessment:
Malnutrition, cancer cachexia, and unintended weight loss are the main contributors to cancer
deaths in the US. The Patient Generated Subjective Global Assessment (PG-SGA) and the
Malnutrition Universal Screening Tool (MUST) are used to assess the patient’s nutritional risk.
The PG-SGA scores for weight changes, abdominal pain, early safety, fatigue, mucositis, taste
changes, changes in appetite, dysphagia, and other symptoms.
Nutrition Diagnosis

Possible nutritional diagnoses include:

● Involuntary weight loss
● Increased energy and protein needs, inadequate oral intake
● Malnutrition
● Inadequate fluid intake
● Altered GI function
● Unsupported beliefs about food and nutrition related topics

Nutrition Intervention

For leukemia and lymphoma cancers, patients are recommended to undergo chemotherapy or
radiation therapy. In these therapies, symptoms vary depending upon the nutritional status
before treatment and the support from the cancer care team. Patients may choose to do a
Hematopoietic Stem Cell Transplant (HSCT) from a donor or from their own body. Patients that
choose this option are at a higher risk for experiencing toxicities such graft-versus-host disease
(GVHD). This disease causes the patient to become extremely immunosuppressed, therefore it
is important to consider this in nutritional interventions.

It is recommended to treat the side effects associated with the cancer treatments to effectively
treat malnutrition and their ability to respond to care.

According to the Nutritional Guide for Clinicians on Lymphomas and Leukemia neoplasia,
“Limited evidence suggests that low-fat, plant-based diets may reduce the risk of this disease. It
is not yet known whether dietary factors can influence its course.”

Diets that implement the MyPlate model with paying close attention to fruit and vegetable
consumption, low fat dairy, lean proteins, and whole grains are standard practice in maintaining
good health. If patients are not able to meet these guidelines through regular diet alone,
consider supplementing with protein shakes or Omega-3 fatty acid supplementation to help
stabilize weight. If needed, appetite stimulants such as megestrol acetate can also be used.

Nutritional Risk factors:

Reducing consumption of Animal products
There are several studies that show a correlation between the consumption of animal products
and the prevalence of NHL and HL. This mainly has to do with saturated fat intake from
processed meats, cheeses, milk, and eggs.

Increasing Fruit and vegetable consumption

Like in many cancers, an increase in Fruit and vegetable consumption has shown to protect
against many cancers or limit the spread within the body.

High Vitamin C and A intake

In the Women’s Health Initiative studies, there was a relationship with Vitamin C and provitamin
A carotenoid consumption and the likelihood of being diagnosed with NHL and HL.

Obesity: Overweight and obese individuals are more likely to develop NHL and HL. Specifically,
there is a correlation between weight gain in early adulthood(18-21 years old) that proposed an
increased risk.
Sources:

American Cancer Society. (2020). Lymphoma Cancer: Understanding Lymphoma. Retrieved

October 14, 2020, from https://www.cancer.org/cancer/lymphoma.html

American Cancer Society. (n.d.). Leukemia. Retrieved October 14, 2020, from
https://www.cancer.org/cancer/leukemia.html

Lymphoma. (2018). In Barnard, N. D. (Ed.), Nutrition Guide for Clinicians (3rd edition). Physicians
Committee for Responsible Medicine. Retrieved October 14, 2020, from
https://nutritionguide.pcrm.org/nutritionguide/view/Nutrition_Guide_for_Clinicians/1342083
/all/Lymphoma

Nelms, M., Sucher, K. P., & Lacey, K. (2016). Neoplastic Disease. In Nutrition Therapy and
Pathophysiology (3rd ed., pp. 687-705). Boston, MA: Cengage Learning.