Related Subjects:
|Hodgkin Lymphoma
|Non Hodgkin Lymphoma
|Diffuse large B-cell lymphoma
|Intravascular large B-cell lymphoma
|Mantle cell lymphoma
|Marginal Zone Lymphoma
|Gastric (MALT) Lymphoma
|Primary CNS Lymphoma (PCNSL)
|Burkitt's lymphoma
|Follicular Lymphoma
Most of the patients remain incurable and, in 10 years, 15% to 28% of cases will transform into an aggressive phenotype, typically diffuse large B-cell lymphoma (DLBCL) which usually requires more intensive types of treatment.
About
- Most common indolent (slow-growing) form of non-Hodgkin Lymphoma (NHL)
- Accountings for 1 out of 5 lymphomas in the US.
- Usually aged > 50. Median age of 65 years many > 75 years
Aetiology
- slow growth of cancerous B-lymphocytes in lymph nodes, bone marrow
- t(14;18)
- See Non Hodgkin Lymphoma
Clinical
- Painless Swelling of Lymph Nodes: Often in the neck, armpit, or groin.
- Fatigue: Persistent tiredness or weakness.
- Fever: Unexplained, recurrent fevers.
- Night Sweats: Particularly heavy sweating at night.
- Weight Loss: Unintentional loss of weight over a short period.
Investigations
- FBC, U&E, LFTs, ESR, CRP, LDH, B2 microglobulin
- CT and PET scan for staging
- Bone marrow aspirate and biopsy
- HIV, HCV, HBV
- Flow Cytometry: This test helps to analyze the types of cells involved and confirm the diagnosis.
Scoring Prognosis
The introduction of anti-CD20 monoclonal antibody (Rituximab) has definitely improved the outcome of these patients as shown by many studies
Management
- Sometimes a watch and wait strategy is used. The disease is usually very responsive to radiation and chaemotherapy. Radiation alone can provide long-lasting remission in some patients with early disease
- Treatment is started if the patient begins to develop lymphoma-related symptoms
- Monoclonal antibodies obinutuzumab (Gazyva) or rituximab(Rituxan). Rituximab hyaluronidase human (Rituxan Hycela) canbe administered as a subcutaneous (under the skin) injection.
- Chemotherapy regimens include
- Bendamustine (Treanda) and obinutuzumab (Gazyva)
- R-Bendamustine (rituximab [Rituxan] and bendamustine)
- R-CHOP (rituximab, cyclophosphamide, doxorubicin,vincristine, and prednisone)
- R-CVP (rituximab, cyclophosphamide, vincristine, andprednisone)
- R-Lenalidomide (rituximab and lenalidomide [Revlimid]), often referred to as R2 (R-squared)
- Some monoclonal antibodies such as obinutuzumab (Gazyva),can also be used as maintenance therapy to prolong remission inpatients with no signs of lymphoma.
- After treatment, many patients can go into a remission that lasts for years; however, this disease should be considered a chronic or lifelong condition.
References