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 patients with follicular lymphoma remain incurable, and within 10 years, around 15โ28% of cases will transform into an aggressive phenotype, most often diffuse large B-cell lymphoma (DLBCL). This requires more intensive treatment.
๐ About
- The most common indolent (slow-growing) non-Hodgkin lymphoma (NHL).
- Accounts for ~20% of lymphomas in the US.
- Typically affects patients >50 years, with a median age of 65 (many >75 years).
โ๏ธ Aetiology
- Clonal proliferation of malignant B-lymphocytes in lymph nodes and bone marrow.
- Characteristic cytogenetic abnormality: t(14;18), leading to overexpression of BCL2 (anti-apoptotic protein).
- Part of the wider group of non-Hodgkin lymphomas.
๐ฉบ Clinical Features
- ๐ก Painless lymphadenopathy โ often cervical, axillary, or inguinal.
- ๐ด Fatigue and malaise.
- ๐ก๏ธ Recurrent fevers of unknown origin.
- ๐ Night sweats (profuse).
- โ๏ธ Unexplained weight loss.
๐ Investigations
- Bloods: FBC, U&E, LFTs, ESR, CRP, LDH, ฮฒ2-microglobulin.
- Imaging: CT and PET scans for staging.
- Bone marrow aspirate and trephine biopsy.
- Screening: HIV, HCV, HBV serology.
- Flow cytometry โ confirms B-cell phenotype and clonality.
๐ Prognosis Scoring
The introduction of anti-CD20 monoclonal antibodies (Rituximab) has significantly improved outcomes and prolonged remission in many patients.
๐ Management
- ๐ Watch-and-wait in asymptomatic, early-stage disease โ treatment is not always immediately necessary.
- ๐ Radiotherapy: In selected patients with localized disease, can provide long-term remission.
- ๐ Immunotherapy:
- Rituximab (IV) or Rituximab Hyaluronidase (SC).
- Obinutuzumab (Gazyva) โ alternative anti-CD20 antibody.
- ๐ Chemotherapy regimens:
- Bendamustine + Obinutuzumab.
- R-Bendamustine (Rituximab + Bendamustine).
- R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, Prednisone).
- R-CVP (Rituximab, Cyclophosphamide, Vincristine, Prednisone).
- Rยฒ regimen: Rituximab + Lenalidomide (Revlimid).
- ๐ก๏ธ Maintenance therapy: Obinutuzumab or Rituximab in remission can prolong disease control.
- ๐ก Disease is usually chronic/lifelong, but long remissions are possible with appropriate therapy.
๐ References
