If you’re living with other health conditions in addition to lymphoma, they may affect your cancer prognosis (outlook) and which lymphoma treatment options are available to you.

Lymphomas are cancers of the lymphatic system, which is part of the circulatory and immune systems. Lymphoma occurs when white blood cells called lymphocytes grow out of control. There are two primary types of lymphoma — Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL).

Understanding the relationship between lymphoma and other health conditions can help you talk to your doctor about treatment and lifestyle changes. Better management of related conditions may improve your quality of life, prolong survival, and lower the risk for life-threatening complications.

Comorbid Conditions

When a person has more than one health condition at the same time, the conditions are known as comorbidities. Having a comorbidity can complicate lymphoma treatment and add to the challenges of cancer.

Age can increase the likelihood of developing a comorbidity. Older adults are more likely to have multiple chronic conditions. A study of nearly 5,000 people with NHL who were older than 66 found that 52 percent had at least one comorbidity.

Some types of lymphoma, such as diffuse large B-cell lymphoma (DLBCL) and mantle cell lymphoma, are more common in older people.

How Do Doctors Assess the Severity of Comorbidities?

Many studies use the Charlson Comorbidity Index (CCI) to assess the severity of a person’s comorbidities. The CCI predicts 10-year survival by considering age and the presence of various health conditions — including heart failure, chronic obstructive pulmonary disease (COPD), diabetes, and liver disease. A person’s score is determined by points assigned to their age and any comorbidities they may have. A higher score indicates a greater number of comorbid conditions and a higher risk of dying from these comorbidities.

Why Do Comorbidities Matter?

Having health conditions in addition to lymphoma can impact your care team’s treatment decisions and which therapies are available to you. Your health care provider may suggest lower doses of chemotherapy drugs or alternate treatment plans to minimize side effects and reduce the risk of complications.

Additional medical conditions may also make a person a poor candidate for a stem cell transplant. Stem cell transplantation requires the use of high-dose chemotherapy that may be difficult for an older person or someone with other health issues to tolerate. Allogeneic stem cell transplants (transplants using donor cells) can be especially difficult because of significant side effects, which may impact someone with comorbidities more intensely.

Comorbidities may also influence your prognosis. A retrospective study of 181 people with DLBCL found that complete remission rates were higher among people with a score of 0 to 1 on the Charlson Comorbidity Index compared to a score of 2 or greater — 77 percent compared to 50 percent. The study also found that the three-year overall survival rate was higher among those with fewer comorbid conditions.

While the impact of comorbidities on disease outlook is concerning, it’s important to remember that every individual’s prognosis is dependent on their specific health factors. You can work with your health care team to determine the best treatment plan for you.

Common Comorbidities With Hodgkin Lymphoma

A British study of comorbidities and cancer found that approximately 30 percent of 7,420 people with HL had at least one comorbidity. Nearly 13 percent of the people with HL in the study had two or more comorbidities. According to the same study, the most commonly occurring comorbid conditions for people with HL included:

• High blood pressure
• COPD
• Diabetes
• Kidney disease
• Cardiovascular disease

Common Comorbidities With Non-Hodgkin Lymphoma

Many people with NHL have a comorbid condition at the time of diagnosis. A Dutch study of 904 people with non-Hodgkin lymphoma found the following comorbidities were most prevalent in people with NHL:

• Cardiovascular disease
• High blood pressure
• COPD
• Diabetes

HIV-Related Lymphoma

HIV infection can increase the likelihood of developing lymphoma. Compared to someone without HIV, a person living with HIV is 10 to 20 times more likely to develop NHL and eight times more likely to develop HL. The risk of a person with HIV developing lymphoma has decreased dramatically since the peak of the AIDS epidemic, thanks to the availability of better treatments for HIV.

Most HIV-related lymphomas are types of non-Hodgkin lymphoma. The following are types of NHL that most commonly occur in people with HIV.

Burkitt Lymphoma

Burkitt lymphoma accounts for approximately 10 percent of lymphoma cases in people with HIV. Burkitt lymphoma is considered an AIDS-defining cancer. In other words, if you have HIV and are then diagnosed with Burkitt lymphoma, you are considered to have AIDS — the most severe stage of immune deficiency caused by HIV infection.

Diffuse Large B-Cell Lymphoma

DLBCL accounts for about 50 percent of lymphomas related to HIV infection. Two rare subtypes of DLBCL are commonly associated with HIV: primary central nervous system lymphoma and plasmablastic lymphoma. DLBCL is also an AIDS-defining cancer.

Primary Effusion Lymphoma

Primary effusion lymphoma is a very rare type of NHL that most commonly affects younger people with HIV. Primary effusion lymphoma accounts for just 4 percent of HIV-related lymphomas.

Treatment for HIV-Related Lymphomas

HIV-related lymphomas can be treated, and treatments generally work as well for people living with HIV as for people without HIV. In some cases, lymphoma treatment may look slightly different with HIV. For example, lower doses of cancer drugs may be necessary because of the impact of HIV on the immune system. There may also be additional treatments to prevent infections.

Conditions Related to Lymphoma Treatment

Lymphoma treatments can cause long-term and delayed effects, beginning months or years after treatment is complete. These are known as long-term or late sequelae. Sequelae are conditions that follow after another disease or injury.

Some common sequelae after treatment for blood cancer include:

• Difficulties with memory or concentration
• Depression, post-traumatic stress disorder (PTSD), or other mental health conditions
• Heart damage, including chronic heart failure
• Thyroid issues that affect the metabolism
• Lung damage or breathing problems
• Osteoporosis (thinning of the bones)
• Infertility
• Problems with the immune system
• Hearing loss
• Cataracts (cloudy areas in the eye’s lens)
• Other types of cancer, including breast cancer and thyroid cancer

Not everyone treated for lymphoma develops sequelae. A person’s risk for developing sequelae after treatment is influenced by the type of lymphoma treatment they received, their age, and other individual health factors.

Talking to Your Doctor About Related Conditions

Your doctor can help you understand your individual risk factors for developing related conditions and recommend steps to lower your risk. Always make sure your health care provider is aware of every medication you take for every condition, whether it is available over the counter or by prescription, including any vitamins or herbal supplements. Some medications can cause dangerous interactions. Open communication with your doctor ensures you can be partners in decision-making about your health.

Find Support When You Need It Most

MyLymphomaTeam is the social network for people with lymphoma and their caregivers. On MyLymphomaTeam, more than 19,000 members come together to ask questions, give advice, and share their experiences with others who understand life with different forms of lymphoma.

Do you have other health conditions in addition to lymphoma? How have you worked with your care team to manage both? Share your experience in the comments below, or start a conversation by posting on your Activities page.