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B-Cell Lymphomas

Follicular Lymphoma

Mantle Cell Lymphoma

Diffuse Large B-Cell Lymphoma (DLBCL)

Burkitt's Lymphoma

Chronic Lymphocytic Leukaemia (CLL)/Small Lymphocytic Lymphoma (SLL)

Marginal Zone Lymphomas

Extranodal Marginal Zone B-Cell Lymphoma of Mucosa-Associated Lymphatic Tissue (MALT) Type

Splenic Marginal Zone Lymphoma (SMZL)

Nodal Marginal Zone Lymphoma (NMZL)

Lymphoplasmacytic Lymphoma

Waldenstrom's Macrglobulinemia

B Cell Acute Lymphoblastic Leukaemia/Lymphoma (B-ALL)

Cutaneous B Cell Lymphoma (CBCL)


 

Follicular Lymphoma

Follicular lymphoma is the most common sub-type of indolent (slow-growing) NHL, comprising 20% to 30% of all NHL. Follicular lymphoma typically affects middle-aged or older adult. Like most indolent lymphomas, people diagnosed with follicular lymphoma usually have lymphoma in many parts of the body at the time of diagnosis. A small percentage of people with FL can have their lymphoma transform into a more aggressive form of NHL, usually a DLBC over time.

What are the symptoms?

The most common sign of follicular NHL is painless swelling in the lymph nodes of the neck, armpit or groin. More commonly more than one group of nodes is affected.

How is it treated?

Treatment for follicular lymphoma depends on the stage of the lymphoma.

  • Early stage: People who are diagnosed at an early stage (stage 1 or 2) may receive no treatment (Watchful Waiting approach) or radiotherapy or chemotherapy.
  • Later stage: People who are at a later stage (stage 3 or 4) at the time of diagnosis but who are not experiencing symptoms may receive no treatment (Watch & Wait approach) with very close monitoring.

Once the need for treatment arises the most common treatments include:

  • Chemotherapy medicines with the addition of a monoclonal antibody. These can be used alone or in combination with radiotherapy
  • Prolonged treatment with MabThera (called MabThera maintenance therapy) may also be used to treat people with follicular NHL who have received treatment for follicular lymphoma and have achieved remission (complete or partial remission). This prolonged administration with MabThera maintenance therapy (generally administered every three months for a period of two years) has been shown to sustain the response obtained from the initial therapy and may improve survival for people with follicular lymphoma.

Follicular NHL usually responds quite well to chemotherapy. However, there is a risk that it may return in future years. At that time, treatment is given again with the aim of achieving remission again. This pattern may repeat itself over many years.or some patients with relapsed FL, high-dose chemotherapy and an autologous stem cell transplant (in which patients receive their own stem cells) or an allogeneic stem cell transplant (in which patients receive stem cells from a donor) may provide a prolonged disease-free interval.

It is critical to remember that today's scientific research is continuously evolving. Treatment options may change as new treatments are discovered and current treatments are improved. Therefore, it is important that patients check with their clinician for any treatment updates that may have recently emerged.

Follow Up

Because FL is generally characterized by multiple disease relapses after responses to a variety of treatments, patients in remission should have regular visits with a clinician who is familiar with their medical history as well as with the treatments they have received. Medical tests (such as blood tests CAT and PET scans) may be required at various times during remission to evaluate the need for additional treatments.

Some treatments can cause long-term effects or late effects, which can vary based on duration and frequency of treatments, age, gender, and overall health of each patient at the time of treatment. The doctor will check for these effects during follow-up care.

Lymphoma survivors should receive regular medical exams from a physician who is familiar with their medical history as well as the treatments they have received. Survivors and their caregivers are encouraged to keep copies of all medical records and test results as well as information on the types, amounts and duration of all treatments received. This documentation will be important for keeping track of any effects resulting from treatment or potential disease recurrences. Please order your free lymphoma diary from our resource section.  

Mantle Cell Lymphoma

Mantle cell lymphoma ( MCL) is an aggressive lymphoma that most commonly affects men more than women over the age of 50 years. It is relatively uncommon and accounts for approximately 5% to 10% of all NHL cases.

What are the symptoms?

The most common symptom is a painless swelling of the lymph nodes in the neck, armpit or groin, caused by enlarged lymph nodes. Often lymph nodes in more than one area of the body are affected. Splenomegaly (enlargement of the spleen) is relatively frequent and may cause a feeling of fullness in the abdomen after eating only small amounts.

Mantle cell lymphoma can grow aggressively (fast) and may spread to other organs in the body, including the bone marrow, spleen and liver. It can also spread to the stomach or digestive tract.Mantle cell lymphoma is usually widespread at the time of diagnosis. Lymph node biopsy is used to confirm the diagnosis. Other tests including X-rays, bone marrow biopsy, CT scans and blood tests may also be performed.

How is it treated?

Mantle cell lymphoma is usually treated with combination chemotherapy medicines with the addition of a monoclonal antibody. Mantle cell lymphoma can also be treated with radiation therapy, stem-cell transplant and targeted therapies.

Diffuse Large B-Cell Lymphoma (DLBCL)

What is it?

DLBCL is an aggressive B-cell NHL and is the most common type of NHL accounting for 30% to 40% of all cases.The average age of diagnosis for DLBCL is the mid-sixties, however this cancer can also affect adolescents and children.

Mediastinal large B-cell lymphoma is a sub-type of DLBCL, where the cancer arises in the thymus gland and lymph nodes behind the mediastinum (the area in the middle of the chest, between the lungs). Mediastinal large B-cell lymphoma can lead to symptoms of shortness of breath, cough and pain in the chest and cause swelling of the neck, arms and face due to the swollen lymph nodes pressing on the veins in the chest (this swelling is known as “superior vena cava obstruction”). This form of DLBCL may occur at any time from early adulthood to old age but is most common between the ages of 25 and 40 years. It is twice as common in women as in men.

What are the symptoms?

The most common symptom of DLBCL is a painless swelling in the  lymph nodes in the neck, armpit or groin caused by enlarged lymph nodes. Often lymph nodes in more than one area of the body are affected.

Usually, the disease is widespread at the time of diagnosis, with symptoms including weight loss, fever and night sweats.

Some people have organ involvement at the time of diagnosis with the most common organs involved being the digestive (gastrointestinal) tract and the bone marrow.

Diagnosis  

The diagnosis of DLBCL is confirmed by a lymph node biopsy. When looked at under a microscope, the tumour cells of DLBCL appear large in size and display a diffuse or scattered pattern. Other tests including X-rays, bone marrow biopsy, CT scans and blood tests may also be performed.

How is it treated?

The standard treatment for DLBCL is a monoclonal antibody plus combination chemotherapy medicines. Other therapies include radiotherapy, stem-cell transplants and steroid therapies. This type of aggressive NHL is very sensitive to treatment and a large percentage of people with DLBCL can be cured.

Burkitt’s Lymphoma

Burkitt’s lymphoma (BL) is a very aggressive form of NHL and commonly affects both children and adults, with males being affected more frequently than females.The disease may be associated with viral infection such as the human immunodeficiency virus (HIV) and the Epstein-Barr virus more commonly known as glandular fever.

Burkitt’s lymphoma accounts for 30% to 40% of all childhood lymphomas and occurs in children between the ages of 5 and 10 years and in adults between the ages of 30 and 50 years.

What are the symptoms?

The most common symptoms are swollen lymph nodes and abdominal swelling. Burkitt’s lymphoma may also affect other organs such as the eyes, ovaries, kidneys, central nervous system and glandular tissue such as breast, thyroid or tonsil. Disease in these organs may cause variable symptoms.

The diagnosis of Burkitt’s lymphoma is confirmed by a lymph node biopsy. Other tests including X-rays, bone marrow biopsy, CT scans and blood tests may also be performed.

How is it treated?

Although Burkitt’s lymphoma has a very aggressive course, survival rates with treatment are very high. The most common treatment for Burkitt’s lymphoma is intensive combination chemotherapy medicines with the addition of  a monoclonal antibody therapy. Other treatmemts include stem-cell transplants when required.

Chronic Lymphocytic Leukaemia (CLL)/Small Lymphocytic Lymphoma (SLL)

  • Chronic lymphocytic leukaemia (CLL) and small lymphocytic lymphoma (SLL) are lymphomas that affect mature B cells. They affect men and women equally and are rare in children. CLL accounts for around 15% and SLL accounts for 4-5% of all NHL cases. CLL and SLL are essentially the same disease, the only difference being where the cancer primarily occurs. When most of the cancer cells are located in the bloodstream and the bone marrow, the disease is referred to as CLL, although the lymph nodes and spleen are often involved. When the cancer cells are located mostly in the lymph nodes, the disease is called SLL.

    CLL/SLL tends to be an indolent (slow-growing) cancer; however, over time, it can progress to a more aggressive type of lymphoma. Common signs of disease include a swelling of the liver and spleen and enlargement of the lymph nodes in the neck, underarm, stomach, or groin. Other symptoms of CLL/SLL can include fatigue, shortness of breath, anaemia, bruising, night sweats, weight loss, and frequent infections. Often, people with CLL/SLL have no obvious symptoms of the disease at diagnosis. Approximately one-third of all CLL/SLL patients will live for years without symptoms.

What are the symptoms?

Symptoms include swollen lymph nodes and an enlarged spleen (splenomegaly), which can cause a mass under the left ribcage, fullness in the abdomen and weight loss. Fatigue, recurrent minor infections or bleeding episodes may also be experienced.

SLL is usually diagnosed by lymph node biopsy. A bone marrow biopsy may be performed if there is minor lymph node involvement and reduced blood cell numbers.

How is it treated?

Initial treatment is often Watch and Wait. Some patients may never require therapy, whilst others develop symptoms of advancing disease and require treatment. Combination chemotherapy with a monoclonal antibody as well as targeted therapies are being used for the treatment of CLL/SLL.

Younger patients with this cancer may also be candidates for a stem cell transplant if required.

Marginal Zone Lymphomas

Marginal Zone Lymphomas (MZL) is a type of indolent lymphoma that accounts for approximately 10% of all NHL cases and has several subtypes. The average age of diagnosis of MZL is 65 years although MALT lymphomas can occur earlier.

Marginal Zone lymphomas can be categorised according to the area affected:

  • Mucosa-associated lymphatic tissue (called MALT lymphoma), which can affect the gastrointestinal tract, eyes, thyroid, salivary glands, bladder, kidney, lungs, neurological system or skin.
  • Spleen (called splenic marginal zone B-cell lymphoma)
  • Lymph nodes (called nodal marginal zone B-cell lymphoma).
  • The average age of diagnosis of marginal zone lymphoma is 65 years, although MALT lymphomas can occur earlier.

Extranodal Marginal Zone B-Cell Lymphoma of Mucosa-Associated Lymphatic Tissue (MALT) Type

Extranodal Marginal Zone Lymphoma of Mucosa Associated Lymphatic Tissue (MALT) can affect the gastrointestinal  tract, eyes,thyroid,salivary glands, bladder, kidney, lungs, neurological system or skin.  

What are the symptoms?

Symptoms may include upper abdominal discomfort or local symptoms relating to where the disease occurs.

How is it treated?

MALT  lymphoma is often curable when the tumour is localised. Surgery is not often a common treatment for NHL however in MALT lymphoma therapies such as surgery or radiotherapy can be curative. Patinets with more extensive disease are usually treated with single-agent chemotherapy or combination chemotherapy medicines. In a small amount of cases, this type of NHL can transform into the more aggressive diffuse large B cell lymphoma (DLBC)  

People with gastric MALT lymphomas who are infected with bacteria called Helicobacter pylori can achieve long remission in the majority of cases once the infection is effectively treated with antibiotics. 

Splenic Marginal Zone Lymphoma (SMZL)

SMZL is a type of indolent B-cell NHL that predominantly involves the spleen. It is a rare type of lymphoma accounting for less than 1% of all NHL. It most commonly occurs in adults and slightly more frequently in women than in men.

What are the symptoms?

Symptoms do not normally appear until years after the disease has begun. The most common symptom is an enlarged spleen (splenomegaly). Unlike many other types of NHL, there are normally no swollen lymph nodes.

There is usually involvement of the blood and bone marrow at the time of diagnosis, with the only other symptom being fatigue.

Diagnosis is based on identification of the cell type together with the typical clinical findings. A biopsy of the bone marrow can often confirm diagnosis however removal of the spleen (splenectomy) is occasionally required for tissue examination.

How is it treated?

  • A number of different approaches may be taken with SMZL, including Watch and Wait, removal of the spleen (splenectomy), radiotherapy, chemotherapy medicines with a monoclonal antibody and targeted therapies.

Nodal Marginal Zone Lymphoma (NMZL)

NMZL is a type of lymphoma that is mainly confined to the lymph nodes. 

It is a rare form of lymphoma, accounting for only 1% to 3% of all NHL cases.

What are the symptoms?

The most common symptom is a painless swelling in the neck, armpit or groin caused by enlarged lymph nodes. Sometimes more than one group of nodes is affected.

NMZL is diagnosed by lymph node biopsy.

How is it treated?

The most common treatments for NMZL include Watch & Wait, radiotherapy and combination chemotherapy medicines with a monoclonal antibody.

Waldenstrom's Macroglobulinemia (WM)

Waldenstrom's  lymphoma is a rare form of B-cell lymphoma, making up 1% to 2% of all NHL cases and typically affects older adults. WM normally develops over a long period of time. Symptoms are not usually very obvious and the cancer is often found by chance when getting a routine bllod test or an examination for some other reason.  

What are the symptoms?

Symptoms may include weakness, fatigue and bruising as a result of altered blood cell levels. Lymph nodes may be enlarged, as may the liver and spleen.

Because there may be a thickening of the blood when the IgM antibody is present, this can cause other symptoms including blurry vision, headaches, hearing loss or confusion.

Other tests that help confirm the diagnosis include bone marrow biopsy, ultrasound and/or CT scan (to determine whether the spleen or liver are enlarged).

How is it treated?

  • Treatment may include combination chemotherapy medicines with a monoclonal antibody, targeted therapies or surgery to remove the spleen.  A procedure called plasma exchange (or plasmapheresis) may be used to treat the blood thickening (hyperviscosity) associated with this disease by temporarily taking out the affected plasma and reaplcing it with donated plasma. This will not treat the disease directly but give some relief of symptoms of the lymphoma.

B Cell Acute Lymphoblastic Leukaemia/Lymphoma (B-ALL)

What is it ?

B-cell Acute Lymphoblastic Leukaemia/Lymphoma (B-ALL) is a type of aggressive lymphoma that occurs mainly in children and adolescents, with two-thirds being male. A second peak of occurrence happens later in life in people over 40 years of age. 

Lymphoblastic cancers are classified as either lymphoblastic leukaemias or lymphoblastic lymphomas. Both are cancers of immature lymphocytes.

Common symptoms include pallor (paleness of skin), fatigue, bleeding, fever and recurrent infections. At the time of diagnosis other sites outside of the lymph nodes may also be affected and may cause symptoms such as swollen lymph nodes, enlarged liver or spleen, neurological disturbances, enlargement of testicles in men or skin involvement. The diagnosis is usually made by bone marrow biopsy as this typically shows high numbers of the cancerous B-cell lymphoblasts

How is it treated?

The treatment involves combination chemotherapy medicines and a monoclonal antibody, and stem cell transplants where required.

Cutaneous B Cell Lymphoma (CBCL)

Cutaneous B Cell Lymphoma (CBCL) is a type of lymphoma that is almost always slow growing and it has a few different subtypes including Primary Cutaneous Follicle Centre Lymphoma, Primary Cutaneous Marginal Zone Lymphoma and Primary Cutaneous Diffuse Large B Cell Lymphoma (leg type). 

Common symptoms include a rash or nodules over any part of the body which are different depending on the type of lymphoma, itch and fatigue.