Diffuse Large B-Cell Lymphoma
Diffuse large B-cell lymphoma (DLBCL), caused by a mutation in B cells, is one of the more common lymphoma types. There is no single cause, but having a family history of DLBCL could be a risk factor. Although DLBCL can affect people of any age, it occurs more commonly in older people, with the average age at the time of diagnosis in the mid sixties.
DLBCL often starts as a mass in a lymph node you can feel or in a lymph node in the chest or abdomen, but it can also start in areas such as the intestines, bones, brain, or spinal cord. Although DLBCL tends grow quickly, it can respond well to treatment. Overall, about 3 out of 4 people will have no signs of disease after the initial treatment, and many of them are considered cured, according to the American Cancer Society.
A subtype of DLBCL called primary mediastinal B-cell lymphoma occurs mostly in young women. It starts in the middle of the chest behind the breastbone and is also fast growing.
Treatment for DLBCL usually includes a chemotherapy regimen of four drugs known as CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone), plus the monoclonal antibody rituximab (in this case it’s called R-CHOP). This regimen is usually given in cycles three weeks apart. Because doxorubicin can damage the heart, other regimens may be used for patients with heart problems.
If R-CHOP is not completely successful, or if DLBCL comes back after treatment, doctors will often recommend a different chemo regimen. Other options for DLBCL that doesn’t respond well to chemo may include immunotherapy (such as CAR T-cell therapy or a monoclonal antibody) and targeted drug therapy.
Follicular lymphoma is a slow-growing lymphoma that generally affects older people. The average age of people with follicular lymphoma is about 60. Usually, this lymphoma occurs in many lymph node sites in the body, as well as in the bone marrow.
Because follicular lymphoma is slow growing, doctors often delay treatment until the lymphoma starts causing health problems. Treatment depends on where this lymphoma occurs and how advanced it is.
In the early stages of follicular lymphoma, radiation is used. Chemotherapy plus a monoclonal antibody might follow radiation therapy.
For lymphoma in the later stages, or if the lymphoma is larger, the most common treatment is a monoclonal antibody combined with chemo. Targeted drugs, immunotherapy, and even a stem cell transplant are options if the lymphoma doesn’t respond to the initial treatment or if it returns.
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Small Lymphocytic Lymphoma
Small lymphocytic lymphoma (SLL) is similar to a leukemia called chronic lymphocytic leukemia. SLL is difficult to cure but grows slowly, so many people can live a long time with it. SLL requires monitoring because it can become a more aggressive, fast-growing type of lymphoma.
SLL in early stages may be treated with radiation therapy alone. More advanced cases are treated with chemo drugs. The drugs used depend on the patient’s age and health, and whether there are any chromosome changes in the cancer cells. If these treatments don’t work, or if the cancer comes back, targeted drugs or monoclonal antibodies may be used.
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Mantle Cell Lymphoma
Mantle cell lymphoma (MCL) is much more common in men than in women, and it most often appears in people over age 60. It tends to grow quickly and is often diagnosed late, after it has spread throughout the lymph nodes, bone marrow, or spleen.
MCL that is diagnosed after it has already spread widely is usually treated with intense chemotherapy plus immunotherapy. If the lymphoma responds well to this treatment, it may be followed by a stem cell transplant.
Mucosa-Associated Lymphoid Tissue Lymphoma
Mucosa-associated lymphoid tissue (MALT) lymphoma, or extranodal marginal zone B-cell lymphoma, starts in places other than the lymph nodes, including the stomach (gastric MALT lymphoma), lungs, skin, thyroid, salivary glands, and tissues surrounding the eye (non-gastric MALT lymphoma). The average age at the time of diagnosis for people with MALT lymphoma is about 60. These lymphomas grow slowly and are often curable if the cancer hasn’t spread.
Because MALT of the stomach is usually a result of chronic infection with the bacteria H. pylori, early-stage gastric MALT lymphoma (for patients who test positive for H. pylori) is treated with antibiotics combined with drugs to block the stomach’s acid secretion. Treating the infection often cures the lymphoma. If antibiotics are not effective, radiation therapy or immunotherapy is used.
Nodal Marginal Zone B-Cell Lymphoma
This lymphoma starts and usually remains in the lymph nodes. It is treated similarly to follicular lymphoma.
Splenic Marginal Zone B-Cell Lymphoma
This rare lymphoma is found mainly in the spleen, blood, and bone marrow. Because it is slow growing, doctors might recommend not treating it unless symptoms become troublesome. This lymphoma has been linked to hepatitis C, and sometimes treatment for the hepatitis C virus can also treat the lymphoma.
Burkitt lymphoma is a rare lymphoma that is seen more often in children than adults. It is much more common in male patients than in female patients, and also more common in the developing world, where it is linked to infection with the Epstein-Barr virus. It can start as a tumor in the abdomen, ovaries, or testicles. Another type of Burkitt lymphoma (immunodeficiency-associated) is associated with a compromised immune system, which may affect people with HIV or AIDS or those taking immune-suppressing drugs after an organ transplant.
Burkitt lymphoma is fast growing and should be treated soon after diagnosis. Intensive chemotherapy with at least five drugs is typical. If the first chemo drugs aren’t successful, or if the lymphoma comes back, other chemo regimens may be tried. A doctor might suggest a stem cell transplant if the lymphoma goes into remission but isn’t eliminated.
Lymphoplasmacytic Lymphoma (Waldenstrom Macroglobulinemia)
This rare and slow-growing lymphoma is found mainly in the bone marrow, lymph nodes, and spleen. Doctors often recommend monitoring and waiting to treat it unless there are bothersome symptoms. It is usually treated with immunotherapy or chemotherapy.
Hairy Cell Leukemia
Despite the name, hairy cell leukemia (HCL) is considered a type of lymphoma. It is rare, though men are much more likely to get HCL than women, and the average age at diagnosis is around age 50. HCL gets its name from projections coming off the lymphocytes that give them a hairy appearance. HCL, typically found in the bone marrow, spleen, and blood, is slow growing, and some people may never need treatment. Complications like an enlarged spleen or low blood cell count are often reasons to start treatment.
Treatment with chemo may be recommended, sometimes along with a monoclonal antibody. If a person has a painfully enlarged spleen, the doctor may recommend surgery to remove it.
Primary Central Nervous System Lymphoma
Primary central nervous system (CNS) lymphoma affects the brain and spinal cord. CNS lymphoma is more common in older people and those who are immunocompromised. Symptoms may include headaches, confusion, vision problems, weakness, and an altered sensation in the face, arms, or legs. In some cases, CNS lymphoma can cause seizures.
Chemo and radiation are typically used to treat CNS lymphoma. If CNS lymphoma is resistant to radiation and chemo, stem cell transplantation may be an option if the patient is healthy enough.
Primary Intraocular Lymphoma (Lymphoma of the Eye)
This rare lymphoma begins in the eye and may occur with CNS lymphoma. Most people with lymphoma of the eye are elderly or have immune system dysfunction. Symptoms may include bulging of the eye, reduced or blurry vision, and a change in the position of the eye within the socket. An eye exam by an ophthalmologist is usually the first step in diagnosing this kind of lymphoma.
If lymphoma is limited to the eye, external-beam radiation is usually the first line of therapy. Chemo may be used with radiation, depending on how far the lymphoma has spread outside the eye. Monoclonal antibodies may also be given directly into the eye.
If the lymphoma does not respond to treatment, or if it comes back, high-dose chemo followed by a stem cell transplant may be recommended.