Low Grade Lymphoma

  • What is Low grade lymphoma?

Lymphoma is a form of cancer developing from the white cells in the lymph node.

Normally all the white cells are produced in the bone marrow and they  constantly enter the blood stream. Many of the white cells escape the blood and enter the lymph node. Lymph node is a temporary storage space for white cells, where they help to fight infections entering through the skin, or nearby organs before they can enter blood.

Cancer is nothing but abnormal proliferation of cells. If these white cells in the lymph node start proliferating in a rapid manner, that is called as lymphoma.

Low grade lymphomas are ones, that arise from mature white cells and they are classified as low grade as they proliferate less vigorously than other types of lymphoma which proliferates rapidly.

  • How is low grade lymphoma diagnosed?

Low grade lymphomas are of various types such as small cell lymphoma, follicular lymphoma, chronic lymphocytic leukemia (CLL) etc.

Due to excess proliferation, there may be enlarged lymph nodes, any where in the body or sometimes, the white cells enter the blood (as is the case with chronic lymphocytic leukemia)

  • What is the difference between leukemia and lymphoma?

In general, for basic understanding, one can assume that if the cancerous lymphocytes (white cells)  arise from marrow it is called leukemia. If the proliferation arises from lymph nodes, it is called lymphoma. (chronic lymphocytic leukemia is a form of lymphoma, but since it always spill over into the blood and marrow, it is called leukemia)

  • What is the course of Low grade lymphoms?

There is a major difference between low grade lymphomas and high grade lymphomas or acute leukemias.

High grade lymphomas and acute leukemias should be treated immediately after diagnosis. They should be treated vigorously to eliminate all the bad cells as soon as possible. This is a do or die situation.

Low grade lymphomas, since they grow slowly usually need not be treated as an emergency. Some of the cases can wait for months before treatment can be started. And the disease cannot be eradicated completely. So, they tend to come back after few years of treatment, at which time they can be treated again.

However, if low grade lymphomas occur in younger age (even though rare), they should be treated vigorously to achieve a cure. This is possible now a days with stem cell transplantation.

  • What is the aim of treating low grade lymphomas in elderly patients?

In elderly patients, the principle of treatment is to control the disease. As mentioned earlier, aggressive treatment approach to cure the lymphoma completely, is appropriate only in very young individuals. In older people, the disease can be controlled for many more years with simple combination of chemotherapy. And the purpose of treatment is to make them have a reasonable good quality life. AND THERE IS NO NEED TO COMPLETLEY ELIMINATE THE DISEASE. Presence of some residual disease is very common in treated low grade lymphomas.

  • What are the indications for treatment in low grade lymphomas in elderly people?

In elderly people, the indications of treatment are mainly related to rapid tumor proliferation and evidence of symptoms. The symptoms may be related to bone marrow depression causing anemia and thrombocytopenia or due to tumor masses compressing various organs or causing discomfort.

In chronic lymphocytic leukemia, for example, high white cell count alone is not an indication of treatment. Unless there are symptoms or evidence of rapid increase in white cell counts, they can be left alone. Some patients maintain a white cell count of 100 x 109/L for many months and may not need any treatment unless they show signs of progression.

  • What is the role of stem cell transplant in low grade lymphoma?

As mentioned earlier, in very young people non myeloablative stem cell transplants can potentially cure low grade lymphomas. In fit older patients, in whom there is massive disease or early recurrence, autologous transplants can control the disease for a longer time.

Department of Hemato oncology,

Amended on Dec 14th, 2014 @VNCC, GKNM by Dr Suthanthira kannan,

Amended on 2nd Nov, 2016 @ Coimbatore Kidney centre by Dr Suthanthira Kannan

 
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