Lymphoma is a cancer of lymphocytes, which are white blood cells of the immune system that are located in lymph nodes throughout the body. Lymphoma is divided into two main subtypes: Hodgkin lymphoma (HL) and non-Hodgkin Lymphoma (NHL). Within the category of non-Hodgkin lymphoma, there are many different subtypes. Follicular lymphoma is a subtype of non-Hodgkin lymphoma, which is the second most common form of non-Hodgkin lymphoma. Follicular lymphoma can cause enlarged lymph nodes throughout the body as well as an enlarged liver and spleen. This disease can frequently affect the bone marrow as well with lymphoma cells being found circulating in the blood. In addition follicular lymphoma can also affect the gastrointestinal tract. It is known for growing slowly compared to other lymphomas, which mean that many people can have it for many years before they need treatment.
Symptoms of Follicular Lymphoma
Many patients with follicular lymphoma have no symptoms, while some people will notice that their lymph nodes and/or the spleen are enlarged. Follicular lymphoma can also cause fevers, chills, night sweats and unexplained weight loss, so called B-symptoms. If the gastrointestinal tract is affected, then the lymphoma may cause changes in the bowels and abdominal pain.
Risk Factors of Follicular lymphoma
There are no known risk factors for the development of follicular lymphoma.
How Follicular Lymphoma is Diagnosed
A diagnosis is usually made by removing one or more of the enlarged lymph nodes. Since they are many other types of lymphomas that can resemble this disease and the treatments are different, it is important to carefully review the lymph node under the microscope. FISH (fluorescence in-situ hybridization) is a test that can look at changes in the chromosome of the cancer cells that are responsible for making this protein.
Once the diagnosis is made under the microscope, computed tomography (CT) scans of the neck, chest, abdomen and pelvis are necessary to determine the degree of enlargement of the lymph nodes. A bone marrow biopsy is also performed to determine the degree of involvement of the bone marrow. One other test used is flow cytometry, which determines the presence of proteins that are typical of follicular lymphoma. Evaluation of the function of the heart with an echocardiogram or Multiple Gated Acquisition scan (MUGA) is at times necessary before any treatment with adriamycin. This is one of the chemotherapy drugs that is sometimes used and can affect heart function.
Treatment Options for Follicular Lymphoma at Tufts Medical Center
Unlike aggressive types of lymphoma (such as diffuse large B-cell lymphoma), which can be cured by chemotherapy, follicular lymphoma can generally be controlled by therapy but not cured. Hence, the goal of treatment is generally to control symptoms, maintain quality of life, and prolong survival. There are several different regimens for treatment of follicular lymphoma. Two common regiments are R-CVP (rituximab, cyclophosphamide, vincristine and prednisone) or R-CHOP (cyclophosphamide, vincristine, adriamycin, prednisone with rituximab).
Alternatively, radio-immunotherapy can be given where a monoclonal antibody which is bound to a small amount of radioactive material, is administered so that it will bind to the lymphoma cells and irradiated them locally, causing the lymphoma cells to die, while causing less side effects than that of traditional chemotherapy. Bendamustine, a newly approved chemotherapy drug in the US, is also given alone or with rituximab, a combination that may cause fewer side effects than R-CHOP. If the disease has returned and the response to conventional chemotherapy is fading, an autologous stem cell transplant (using the patient’s own bone marrow) is recommended. The only potential curative treatment for follicular lymphoma is an allogeneic stem cell transplant (where bone marrow is donated by another individual).
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