Does Cannabis Help Patients With Lymphoma?
Cannabis can be a powerful therapeutic tool. It has helped many people with a number of conditions. Can it aid people with Hodgkin’s lymphoma and give them a better quality of life?
Lymphoma is a type of cancer that not only displays the trademark side effects of other cancers, but also compromises the immune system, making the patient vulnerable to other diseases. When combined with invasive and stressful treatments like chemo or radiation therapy, Hodgkin’s lymphoma has the potential to be a very debilitating disease.
Hodgkin’s lymphoma or Hodgkin’s disease is a disorder of the lymphatic system. There are lymph nodes all over the body, including in the brain, bone marrow, and spleen. You can feel them as little lumps in your groin, armpits, and along the underside of the jaw. If you can feel them in your bone marrow or brain, you are pressing too hard.
Lymphoma affects the way white blood cells called lymphocytes behave. Lymphocytes are critical for immunity and are antagonistic towards viruses and bacteria. Hodgkin’s lymphoma infects the cells responsible for making antibodies.
Antibodies are protein markers that the body uses to identify invading pathogens. When an invader is identified, the immune system goes to work to seek and destroy. The lymphatic system then drains the harmless waste away and the body continues along, oblivious and healthy.
Hodgkin’s lymphoma turns off the body’s seek and destroy system. Cells that would have been targeted and flushed are now able to multiply as they please. This manifests in the body as swollen lymph nodes, usually in the chest and armpits.
The types of symptoms can vary depending on where the lymphoma begins. Internal glands that swell can put pressure on the stomach and gut, inducing nausea. Masses that appear in the chest or armpits will metastasise to the nearest cluster of lymph glands and so on.
The compromised immune system also makes the patient vulnerable to infection, bacterial diseases, and viruses. When your body gets a cold or the flu, the symptoms you experience are your body’s battle with the pathogen flowing in your blood. All thanks to your immune system.
Without an active immune system, a dose of the flu can be devastating.
CANNABIS AND LYMPHOMA
Research into whether cannabis can fight lymphoma directly has yet to be conducted in any clinical sense. However, there are studies that have given good reason for clinical investigation into the direct effectiveness of cannabis on Hodgkin’s lymphoma.
In a 2013 study  published in the journal PLOS ONE, it was found that the surface of Hodgkin’s lymphoma cells were covered in cannabinoid receptors. These CB1 receptors imply the potential for cannabinoids to bind to or influence them.
There has been encouraging success in the laboratory using cannabis compounds on other forms of cancer. Four primary mechanisms are responsible for the effectiveness of cannabis on different types of cancer cells.
- As an antiproliferative  , cannabis has been found to reduce the growth of tumours.
- It also interrupts metastasis  , which is the process of cancer cells spreading throughout the body.
- As an antiangiogenic  , cannabis has been found to prevent the growth of blood vessels to feed tumours. Without a food supply, tumours are starved.
- Apoptosis  is cell suicide. Normal cells are made, perform their function, wear out or become diseased, and are disposed of by the immune system. This process is happening continuously, millions of times a day. Cancerous cells are those that have stopped responding to normal immune triggers that dispose of diseased cells. Compounds in the cannabis plant convince the cancer cells’ own healing system to self-destruct—ironically and eerily similar to what cancer does to normal cells.
CANNABIS AND QUALITY OF LIFE
Whether cannabis can be effective in the direct fight against Hodgkin’s lymphoma remains to be seen. However, it may be able to help the patient in a number  of other ways. Appropriate use of marijuana and its extracts can ease the symptoms of lymphoma and improve one’s overall quality of life.
PAIN PAIN GO AWAY
Pain is the most common side effect of chemotherapy and often proves to be the most difficult to manage. A number of chemotherapy drugs can cause long-term problems like neuropathy. Neuropathy is an autoimmune disorder where the immune system attacks the nervous system causing chronic, extensive pain.
In general, medical marijuana patients prefer the magical green herb to other pain control medications. Prescription pain medication can have its own debilitating side effects like intoxication and addiction. A significant amount of distress from pain is caused by anxiety about the pain. The classic high experienced when using cannabis can reduce anxiety and make the pain less psychologically agonising.
The nausea and vomiting caused by chemotherapy can be a torment. Cannabis is a proven antiemetic. An antiemetic is a substance that relieves vomiting. Medical marijuana patients benefit from the known antiemetics tetrahydrocannabinol (THC) and cannabidiol (CBD). Being able to eat and digest is an important part of any recovery process.
Dating back to the seventies, studies  confirm the efficacy of cannabis compounds in reducing nausea and vomiting in chemo patients. In the following decades, preclinical trials and reviews backed up these preliminary studies. Medical marijuana has since gained acceptance and a legal status in many countries.
SANE IN THE BRAIN
Battling life-threatening diseases presents challenges in maintaining good mental health. Controlled doses of THC can have similar  effects to that of antidepressants. Cannabis, in its many forms, is renowned for bringing smiles to faces and euphoria to minds.
Rapidly absorbed CBD also has a positive  effect on mood. While many pharmaceutical antidepressants may take several weeks to balance out in the body, studies performed on rodents suggest a positive effect on mood with just a single dose of CBD.
Sleep is an indispensable part of anyone’s life, and is especially important when fighting disease or recuperating. The pain from lymphoma and chemotherapy can interfere with healthy sleep. Research has shown that cannabis helps patients fall asleep quicker, then sleep deeper and longer.
It is during deep sleep that the body and brain undergo regenerative  and restorative processes. Cannabis encourages deeper sleeps for longer periods. Getting good sleep is crucial to maintaining a healthy lymphatic and immune system. Decreased sleep is linked  to poor immune function, which must be avoided at all costs by lymphoma patients.
IT’S CANNABIS NOT CAN’TABIS
Studies will continue to unveil the efficacy of cannabis for treating different kinds of cancer, including Hodgkin’s lymphoma. Again, whether or not cannabis can directly fight this cancer remains to be proven. Nonetheless, cannabis really shines when it comes to easing the side effects of the cancer itself; equally so when used to relieve the side effects of treatments like radiation and chemotherapy.
Cannabis is a well-regarded therapy for a number of diseases and disorders. Can it help with Hodgkin’s lymphoma?
A Clinical Trial of Cannabis As Targeted Therapy for Indolent Leukemic Lymphoma
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Christopher M Melén, Magali Merrien, Agata Wasik, Kristina Sonnevi, Henna-Riikka Junlén, Birger Christersson, Birgitta Sander, Björn E Wahlin; A Clinical Trial of Cannabis As Targeted Therapy for Indolent Leukemic Lymphoma. Blood 2019; 134 (Supplement_1): 5487. doi: https://doi.org/10.1182/blood-2019-126693
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Cannabinoid receptors type 1 (CB1) and type 2 (CB2) are tentative treatment-targets in cancer. They are activated by endogenous cannabinoids and by plant cannabinoids such as tetrahydrocannabinol (THC). CB2 is expressed in normal and malignant lymphocytes while CB1 expression is low in normal lymphocytes but high in mantle cell lymphomas and half of cases of chronic lymphocytic leukemia (CLL). Agonists to CB1 and CB2 induce cell death of CB1 or CB2 expressing lymphoid cell lines (Gustafsson, K. et al. Int J Cancer 2008). CB1 and CB2 regulate tissue localization and homing of leukocytes (Muppidi JR, et al. J Exp Med. 2011; Wasik et al., 2014, Oncoscience).
We here report the effects of Sativex, which contains a whole-plant mixture of Cannabis sativa with exact proportions of THC and the partial CB1-antagonist cannabidiol (CBD), on patients with indolent B-cell lymphoma.
Patients, 18-80 years, with a leukemic indolent B-cell lymphoma without treatment indication, were given a single administration of Sativex, as an oral mucosal spray. The cannabis compound was given at 9 AM and patients were sampled at 0, 2, 4, 6, 24 and 168 hours. They were also sampled at a prior non-treatment day at the same hours of the day to compensate for any circadian rhythms of blood leukocytes.
Blood samples were analyzed using blood chemistry and flow cytometry to quantify lymphoma and non-malignant cells. Apoptosis was measured by caspase-3 activation. CB1 and CB2 mRNA levels were quantified using qPCR in enriched lymphoma cells.
23 patients were included (Table 1). Maximum tolerated dose was determined to be 7 actuations, containing 18.9mg THC and 17.5mg CBD. This dose was given to 15 patients. Side effects were mostly grade 1 and manageable (Table 2) and all patients could return home at 3 PM.
At every time point on the treatment day, there was a significant decrease in lymphocyte counts compared with 0 hours (2 hours, P = 0.004; 4 hours, P 0.4). The cannabis compound reduced lymphocyte levels both in CB1-positive and CB1-negative lymphoma (CB1+, P = 0.028; CB1-, P = 0.013).
This study demonstrates that it is safe to administrate a single dose of Sativex to elderly patients with indolent B-cell lymphoma with regards to adverse events. We show that the cannabis compound quickly reduces lymphoma cell numbers in peripheral blood. There was no evidence of activation of caspase 3; this suggests that the reduction of lymphoma cells in blood might be due to redistribution from blood rather than apoptosis. We have also detected an apparent circadian rhythm of the peripheral numbers of malignant lymphocytes.
Our findings suggest that the drug might promote homing of lymphoma cells from blood into secondary lymphoid organs where they receive pro-survival signals. Therefore, this cannabinoid compound should be used with caution in patients with indolent leukemic lymphomas. Further studies are needed to dissect the signaling pathways affected by cannabinoids in B-cell lymphoma.
IntroductionCannabinoid receptors type 1 (CB1) and type 2 (CB2) are tentative treatment-targets in cancer. They are activated by endogenous cannabinoids and by