Non-Hodgkin's lymphoma on the increase worldwide; Cancer that struck Hussein runs unpredictable course


Non-Hodgkin's lymphoma, the cancer that struck King Hussein of Jordan, comes in many forms. While the prognosis varies significantly according to the type, any form can act unpredictably.

Some such cancers wax and wane over years. Many people live for decades, hardly bothered by their lymphoma. Some may not need treatment for long periods.

Many others, like the king, develop a form that is highly aggressive and succumb swiftly, even after they have an apparently successful bone marrow transplant and other powerful but risky therapies.

Lymphomas are cancers of the lymphatic system, which plays a key role in the body's immune defenses. Because the lymphatic system consists of channels that course through the body like blood vessels, the cancer has a ready route to spread to any organ and tissue.

Doctors have long arbitrarily divided lymphomas into two types: Hodgkin's disease (named for Thomas Hodgkin of London, who first described it as a new disease in 1832) and a dozen other forms grouped as non-Hodgkin's lymphoma. Classification of non-Hodgkin's lymphoma can be confusing because different systems are used.

Hussein's cancer is believed to be the most common type, known as B cell non-Hodgkin's lymphoma. The diagnosis was made less than eight months ago at the Mayo Clinic in Rochester, Minn.

At that time, he had lost weight, was tired and his lymph nodes, normally the size of a pea, had become enlarged.

Like many cancers, King Hussein's initially responded dramatically to large amounts of anti-cancer drugs. Then, to give him the best chance of a cure, cells were taken from his body and stored for what is known as an autologous stem cell transplant.

In the procedure, he received huge amounts of drugs to kill the cancer cells. But the drugs also killed the king's healthy blood cells. So a few days after the chemotherapy regimen was completed, the king received his own cells to supply oxygen and defend against infection while his bone marrow healed and began to make its own cells. That process took several weeks.

More surprising to many people is that on Jan. 19, Hussein made a triumphal return to Jordan and said he was completely recovered.

The news was reassuring to his people because in 1992 the king had recovered from cancer of the ureter, for which doctors at the Mayo Clinic removed his left kidney.

This time, the optimism was misplaced. King Hussein took a sudden turn for the worse. He developed a fever and his blood counts dropped to dangerous levels. That was evidence that the cancer had come back surprisingly fast.

On Jan. 26, hours after changing the line of succession, removing his brother and naming his eldest son as heir to the throne, the king flew back to the Mayo Clinic, where he had spent the last six months of 1998 except for brief periods. Platelets were injected into his veins on the flight to prevent bleeding.

The news at the Mayo Clinic was grimmer than ever. King Hussein was riddled with lymphoma. With precious little reserve in his body, the few drugs left to treat his cancer posed enormous dangers. He started chemotherapy again, but his cancer was uncontrollable.

The last desperate hope was a second bone marrow transplant.

The king underwent the procedure on Monday and Tuesday, using cells from a sibling. But it was unsuccessful. Hours later, his liver and other organs began to fail.

When bone marrow transplants are unsuccessful, the liver often fails because of the effects of the drugs, cancer, infection, or a complication known as veno-occlusive disease that blocks the flow of blood in the liver.

In such situations, if the family wishes, doctors administer drugs to sustain the blood pressure and heartbeat. But ultimately, the cancer wins as the heart stops beating.

This year, 56,000 Americans are expected to develop non-Hodgkin's lymphoma. The disease has been one of the fastest-rising cancers in the United States and elsewhere, although the rate has slowed in this country in the last few years, according to the American Cancer Society.

Pub Date: 2/07/99

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