Deaths from Hodgkin's disease have become relatively rare in recent years, with steady advances in treatment, but the passing of Minnesota Timberwolves executive Flip Saunders shows that the cancer, its complications and even its treatment can swiftly exert a heavy toll.
Team owner Glen Taylor said Monday that Saunders' health changed drastically over a "three to four day period" in early September.
Saunders died Sunday from complications associated with Hodgkin's lymphoma, and details from Taylor were the first on Saunders' rapid decline.
"He got a fever and from that fever … within a day, all of a sudden he was in the hospital. Once he was in the hospital, his situation changed very rapidly," Taylor said.
"I knew how tenuous his situation was, so many things going wrong, but still you always had that hopefulness inside you that he'd turn the corner the other way, and pretty soon we'd be talking basketball with each other again."
Saunders, whose Hodgkin's was diagnosed this summer, joined a list of other celebrity cases that have given the disease a high profile. Hockey star Mario Lemieux's Hodgkin's was diagnosed in 1993; he has since led a foundation that has spent millions on research and treatment. Actor Richard Harris, who played Albus Dumbledore in the first two Harry Potter movies, suffered from Hodgkin's and died in 2004.
Hodgkin's is a form of cancer known as a lymphoma that attacks white blood cells and the protective lymphatic system.
The American Cancer Society estimates that 9,000 new cases appear each year, along with 1,000 related deaths.
Radiation and surgery treatments commonly used for other cancers typically don't work with severe cases of Hodgkin's because of how it spreads among the lymph nodes — filters that absorb foreign particles and can be found from the neck and armpits to the groin.
An intravenous chemotherapy regimen known as ABVD has been the standard of care for nearly 30 years and has turned the odds of survival from unlikely to likely, said Dr. Veronika Bachanova, a hematologist at the University of Minnesota's Masonic Cancer Center.
Today, the one-year survival rate is 92 percent.
A death from Hodgkin's "is very unusual, but it can happen," she said. "Sometimes it unmasks another problem the patient can have."
Bachanova was not involved in the care of Saunders, who was treated at Mayo Clinic and hospitalized in September. A spokesman said Mayo officials would not comment on Saunders' care.
Lymphoma is the seventh-most-common cancer in the U.S., but only 15 percent of lymphomas are diagnosed as Hodgkin's, which is characterized by an abnormality known as the Reed-Sternberg cell.
Hodgkin's commonly emerges among adults in their 20s and 30s and has been linked to childhood or early adult exposure to the Epstein-Barr virus or other viruses that cause malignancies to form in the lymph nodes, Bachanova said. The risk of the cancer then wanes but increases again among individuals 60 and older as aging causes their immune systems to weaken, she added.
"The symptoms are often nonspecific. It can just present with a lump; that pretty much is the most common way it is found," she said. "More advanced disease can present with weight loss, night sweats, fevers or just a failure to thrive."
Survival rates are lower for men and older cancer patients, and for patients whose cancers have spread to multiple lymph nodes or other organs.
Lymphoma in general compromises the body's ability to fend off viruses and bacteria, and chemotherapy can increase the risk of complications from infection. Another potentially fatal complication can come from the chemo itself, because one of the ABVD drugs can be toxic to the heart and lungs. Patients with prior lung or heart diseases receive other chemo regimens, Bachanova said.
The genetics of Hodgkin's are poorly understood, said Dr. Greg Bociek, a lymphoma researcher at the University of Nebraska Medical Center in Omaha, so doctors have been fortunate that "the garden-variety drugs work."
"It's a model of a lymphoma that is so curable in a lot of people that even shooting blind has still produced a pretty good home run rate," he said.
Radiation does work for early-stage Hodgkin's when the cancer hasn't spread broadly among lymph nodes, and other chemotherapies and stem cell transplants are used when inital treatment fails.
A targeted chemotherapy called brentuximab is emerging to treat patients who experience relapses, and is being tested in place of the drug in the ABVD regimen that is linked to heart and lung side effects.
Star Tribune staff writer Jerry Zgoda contributed to this report.