Preface to the Second Edition
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xv Preface to the Second Edition In November 1996, I was diagnosed with non-Hodgkin lymphoma (NHL), a form of cancer. At the time of my diagnosis, I knew very little about lymphoma. Suddenly cast adrift on an unexpected medical leave from work, however, I exploited my background as a biologist to learn everything I could about the disease and its treatment. I was in very bad shape by the time I was diagnosed, and I wanted to do everything I could to tip the balance in my favor. Several years later, I wrote a book, Living with Lymphoma: A Patient’s Guide, intended to help other people diagnosed with lymphoma make sense of their disease and make informed decisions about their treatment options. Living with Lymphoma was designed to provide not only detailed information on lymphoma and its treatment but also a strong enough background in biology (as it applies to lymphoma and its therapy) to enable its readers to read and evaluate articles in the medical literature. I hoped that this background in biology would allow interested readers to keep current with medical advances that took place after the book’s publication . Why, then, am I writing a second edition now? There are three reasons. First, the lymphoma landscape has changed enough over the ten years since Living with Lymphoma was published that some of the material in the first edition has begun to feel dated; the second edition updates this material . At the time I was diagnosed, Hodgkin lymphoma was broadly viewed as the “good” kind of lymphoma and NHL was broadly viewed as the “bad” kind. So pervasive was this perception that, when a friend who had had indolent lymphoma for many years developed Hodgkin lymphoma as well, she was shocked to discover that her friends in the lymphoma community failed to recognize the seriousness of her new diagnosis. They had forgotten that Hodgkin lymphoma was the “good” kind only because highly effective U xvi Preface to the Second Edition regimens had been developed to treat it and that, as someone who had already undergone many rounds of chemotherapy, she might have difficulty standing up to the treatments required to cure her Hodgkin lymphoma. (She ended up doing fine.) Advances in the treatment of NHL since the time of my diagnosis have done much to blur that distinction, and advances in treating both Hodgkin lymphoma and NHL have done much to mitigate the adverse effects of treatment. Reflecting these advances in lymphoma treatment, Part II of the book, which deals with lymphoma therapy, has undergone the most extensive revision . In Chapter 3, I have updated the regimens to those currently used to treat lymphoma, eliminating those that are no longer in common use, and have included material on new antineoplastic and antiemetic agents. Chapter 4 incorporates advances in radiation therapy, adding material on newer approaches designed to maximize the delivery of radiation to tumors and minimize the amount of radiation delivered to healthy tissue. Perhaps the most dramatic advance in lymphoma therapy of the past twenty years has been the introduction of the newer “magic bullet” therapies discussed in Chapter 5. In the first edition of Living with Lymphoma, I described my participation in a clinical trial designed to test the efficacy of incorporating the monoclonal antibody rituximab into the therapy of aggressive NHL. Rituximab’s promise has held up: it’s been a real game-changer and is now part of the standard therapies for treating both indolent and aggressive forms of B-cell NHL. In this new edition of the book, I describe several new monoclonal antibodies, as well as a new form of immunological therapy, chimeric antigen receptor (CAR) T-cell therapy, and some of the exciting new forms of targeted chemotherapies, including those designed to disrupt abnormal signaling downstream of the B-cell receptor. Chapter 6 reflects advances made in stem cell transplants, notably incorporating a discussion of haploidentical transplants, which promise to extend the benefits of allogeneic transplants to people who do not have a sibling who is a perfect six-out-of-six match and have not been able to find an appropriate unrelated donor. Although the most extensive changes have been made to Part II, Parts I and III have also been updated to reflect changes in lymphoma diagnosis (in Chapter 2), the current World Health Organization classification system (Chapter 11), and the possible role of lack of sunlight and vitamin D as a factor in lymphoma pathogenesis (Chapter...