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Introduction

Lymphomas are cancers of the immune system, and at least 900 new cases are diagnosed in Ireland every year. The diagnosis of lymphomas is complex because more than 50 sub-types of the disease have been identified, each of which demands a unique approach to treatment, requiring the diagnostic input of a specialist haematopathology laboratory, molecular diagnostics laboratory and radiology department. Treatment pathways are complex and include ‘watchful waiting’, chemotherapy, antibody treatment, radiation and stem cell transplantation. For some lymphomas, therapy is not indicated.

To help to ensure that each patient receives appropriate treatment, all patients with lymphomas are reviewed at a weekly multidisciplinary meeting (MDM). Over 250 patients are discussed at the MDM annually, including patients from the Midlands Regional Hospital Tullamore, University Hospital Waterford, and University Hospital Limerick.

The accurate and timely treatment of lymphomas is important. They constitute the commonest cancer in young people and are often associated with a high cure rate if an accurate diagnosis is made early on and appropriate treatment is started. Many people with low-grade lymphomas survive with a normal lifestyle for up to 20 years. This suggests that many thousands of patients are under the care of lymphoma specialists in Ireland, making it one of the commonest cancers managed in cancer centres.

  • Lymphomas affect people of all ages. About 900 new cases are diagnosed annually in Ireland, and thousands of patients survive with their lymphomas, managed by lymphoma specialists. Lymphomas are difficult to diagnose accurately, and over 50 subtypes have been identified, each needing different treatment approaches, from outpatient-based treatment to intensive, complex treatments delivered in the transplant unit at the hospital.

  • Patients are referred to the St James’s Hospital Lymphoma Service from local GP practices and from other haematology/oncology services throughout Ireland for the following reasons:

    • The service’s ability to diagnose complex lymphoma types based on a specialist haematopathology and lymphoma radiology service.
    • Its capacity (unique in Ireland) to provide the full range of treatments that may be needed in lymphoma management, including chemotherapy, radiation therapy, bone marrow transplantation and access to clinical trials.

    All patients referred to the lymphoma service are assessed at a multidisciplinary meeting, with video links to the Midlands Regional Hospital Tullamore, University Hospital Limerick and University Hospital Waterford, ensuring diagnostic accuracy and a clear management plan, which is then discussed with the patient.

    The treatment of lymphoma typically takes place in the Haematology-Oncology Day Ward. The chemotherapy is given by a specialist team of nurses. The phlebotomist on duty will take your bloods, and when the results are available you will be reviewed by the doctor and clinical nurse specialist, at which point the decision to proceed to treatment is made.

    Complex inpatient therapy is given in one of three haematology-oncology wards:

    • Denis Burkitt Ward (also the National Adult Bone Marrow Transplant, or BMT, Unit).
    • Donal Hollywood Ward.

    Clinical trials patients are managed in the Haematology-Oncology Day Ward by a specialist team of clinical trial nurses working with the patient’s primary consultant. A dedicated clinical nurse specialist acts as a liaison and advice point for all patients undergoing active treatment for lymphomas in the hospital.

    Radiotherapy involves the very careful delivery of radiation to the part of the body where the lymphoma is located, and it is used to treat many types of lymphoma. If required, it is generally delivered at either the centre at St James’s Hospital or in St Luke’s Hospital. The radiotherapy treatment of lymphoma is usually delivered using external beam linear accelerators, and patients are required to lie still (usually on their back) for five to ten minutes each day during treatment. This is painless and very much like having a normal X-ray. Radiotherapy for lymphoma generally involves daily treatment (Monday to Friday) for two to four weeks. Occasionally, just two to five treatments may be necessary. This decision will be made following consultation with your radiation oncologist.

    Further information is available by following this link: stlukesnetwork.ie/patients/patient-guides/information-booklets/

  • Medical Staff

    • Dr Larry Bacon, MB MRCPI FRCPath Ph.D., Consultant Haematologist, with an interest in stem cell transplantation, acute lymphoblastic leukaemia and lymphomas.
    • Professor Paul Browne, MB FRCPI FRCPath, Consultant Haematologist, with an interest in stem cell transplantation, myeloma and acute leukaemia.
    • Dr Eibhlin Conneally, MB FRCPI FRCPath, Consultant Haematologist with an interest in stem cell transplantation, acute leukaemia and myeloproliferative disorders.
    • Dr Catherine Flynn, MB FRCPI FRCPath, consultant haematologist with an interest in stem cell transplantation, acute leukaemia and bone marrow failure syndromes.
    • Dr Charles Gilham MRCP, Consultant Radiation Oncologist, with an interest in the treatment of lymphoma using radiation.
    • Dr Cliona Grant, MB MRCPI, Consultant Oncologist, with an interest in high grade lymphomas, Hodgkins lymphomas and HIV-associated lymphomas.
    • Dr Patrick Hayden, BA MD FRCPI FRCPath, Consultant Haematologist, with an interest in stem cell transplantation, myeloma and acute leukaemia.
    • Professor Elisabeth Vandenberghe, MB MRCPI FRCPath PhD, Consultant Haematologist, with an interest in stem cell transplantation, lymphomas and lymphoproliferative disorders, including chronic lymphocytic leukaemia.

    JACIE Quality Manager

    • Being appointed this week

    Clinical Nurse Specialists

    • Ms Elizabeth Higgins, Transplant Coordinator.
    • Ms Mairead Ní Chonghaile, Transplant Coordinator.
    • Ms Amy Mullins, Transplant Co-ordinator
    • Ms Therese Harvey, Clinical Nurse Specialist in Lymphoma (Oncology)
    • Ms Grace Faulkner, Clinical Nurse Specialist in Lymphoma
    • Ms Niamh O’Sullivan, Clinical Nurse Specialist in Myeloma
    • Ms Lorraine Brennan, Clinical Nurse Specialist Acute Leaukaemia
    • Ms Carmel Ann Galligan , Clinical Nurse Specialist in Post-Transplant Follow-Up.
    • Ms Majella Moran , Clinical Nurse Specialist in Post-Transplant Follow-Up.
    • Ms Aileen Smith, Clinical Nurse Specialist in Transplant Late Effects Clinic

    European Blood and Marrow Transplantation Data Manager

    • Mr Greg Lee
  • Irish Cancer Society: http://www.cancer.ie

    CanTeen: http://www.canteen.ie

    Lymphoma Association (U.K.): http://www.lymphomas.org.uk/

  • Caroline's journey with non-Hodgkins lymphoma: "The staff are just like family down there really, they'll come into you, they'll have a chat, and anything you need, they'll look after you, they are fantastic people."