Non-Hodgkin's lymphoma: Small lymphocytic lymphoma

• What is Small lymphocytic lymphoma
• Statistics on Small lymphocytic lymphoma
• Risk Factors for Small lymphocytic lymphoma
• Progression of Small lymphocytic lymphoma
• Symptoms of Small lymphocytic lymphoma
• Clinical Examination of Small lymphocytic lymphoma
• How is Small lymphocytic lymphoma Diagnosed?
• Prognosis of Small lymphocytic lymphoma
• How is Small lymphocytic lymphoma Treated?
• Small lymphocytic lymphoma References

What is Small lymphocytic lymphoma

Lymphoma is divided into 2 broad groups: Hodgkin’s lymphoma and non-Hodgkin’s lymphoma. Non-Hodgkin’s lymphoma has many subtypes – and one of them is small lymphocytic lymphoma. Small lymphocytic lymphoma primary affects the B cells. It represents the tissue manifestation of chronic lymphocytic leukaemia (CLL).
Lymphoma means cancer of the lymphatic system. The lymphatic system is important to our immune system where it helps to combat infection. The lymphatic system consists of several organs, e.g. lymph nodes, spleen, thymus and bone marrow, where all these are connected by tiny vessels. Lymphatic fluid is the medium that circulates in these tiny vessels. Like blood, it has cells in them. These cells can be divided into 2 types: T cells and B cells.

Statistics on Small lymphocytic lymphoma

Small lymphocytic lymphoma is one of the subtypes of non-Hodgkin’s lymphoma. It represents 7% of all non-Hodgkin lymphoma. It is one of the common subtypes of indolent (or slow growing) lymphoma.
Racial variation does exist in small lymphocytic lymphoma. This disease is extremely rare in Asian countries like China and Japan. Predisposition to this disease includes caucasian population. Male to female ratio is about 1.7:1.
The median age of diagnosis is 65 years old.

Risk Factors for Small lymphocytic lymphoma

Age: middle-aged to elderly people
Gender: slight male predominance
Racial ethnicity: more common in caucasians, Western society

Progression of Small lymphocytic lymphoma

With respect to the natural history of lymphoma, small lymphocytic lymphoma is one of the indolent (or slow-growing) lymphomas. This means that it has good prognosis but may not be curable.
The course of small lymphocytic lymphoma is extremely variable depending on the clinical stage.
Generally the staging can be summarised as below:
Stage I – involvement of a single lymph node region or organ or site other than lymph nodes
Stage II – 2 or more lymph node regions involved on the same side of diaphragm
Stage III – 2 or more lymph node regions involved on both sides of diaphragm
Stage IV – one or more organs (e.g. bone marrow) involved
Each stage is subclassified into A and B (e.g. IIA), where B means presence of B symptoms (see below) while A means abscence of the following symptoms:

• Unexplained fever higher than 38 Centigrade
• Unexplained weight loss (defined as >10% of body weight in 6 months)
• Night sweats

How is Small lymphocytic lymphoma Diagnosed?

The usual basic tests will be done, including those to look at the blood and other blood components. Other general tests will determine the function of the liver.

Prognosis of Small lymphocytic lymphoma

The prognosis is dependent on the clinical stage when the disease is
diagnosed. The later the stage, the worse the prognosis.
The following criteria are used to determine the prognosis of non-Hodgkin’s lymphoma:
 

• Age >60
• Blood lactate dehydrogenase (LDH) concentration greater than normal.
  Serum LDH is one of the many compounds found in the human blood system.

 
 

• Patient is symptomatic and in bed <50% of the day or worse than this
• Stage III or IV (see above for explanation on staging)
• More than 1 involved site other than lymph nodesDepending on the amount of criteria met, the prognosis is as follows:
• 0-1 76% of patients survive for 5 years
• 2-3 51% of patients survive for 5 years
• 4-5 38% of patients survive for 5 years
  

  How is Small lymphocytic lymphoma Treated?

  Because small lymphocytic lymphoma is an indolent (or slow growing) lymphoma and also it may not respond to treatment, ‘watchful waiting’ may be the choice. However, if symptoms develop, treatment may be started.
  Depending on the stage of disease and also the symptoms it produces, the following treatment modalities can be either given either alone or with combination.
   

• Chemotherapy: this is using chemical (drugs) to kill the cancer cells.
• Radiotherapy: this is using radiation to kill the cancerous cells.
  This is used when there is one or more lymph node regions affected in the same part of the body.
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  Small lymphocytic lymphoma References

  [1] Chronic lymphocytic leukaemia [online]. 2005 [Cited 2005 September 9th]. Available from: URL: http://www.emedicine.com/med/topic370.htm
  [2] Clinical and pathologic features of small lymphocytic, prolymphocytic, and lymphoplasmacytic lymphomas [online]. 2005 [Cited 2005 September 9th]. Available from: URL: http://uptodateonline.com/application/topic.asp?file=lymphoma/9728&type=A&selectedTitle=1~5
  [3] Clinical Practice Guidelines for the Diagnosis and Management of Lymphoma [online]. 2004 [Cited 2005 September 9th]. Available from: URL: http://www.cancer.org.au/documents/chpt12_Lowgrade_lymphoma.pdf
  [4] Small lymphocytic lymphoma [online]. 2004 [Cited 2005 September 9th]. Available from: URL: http://www.cancerbacup.org.uk/Cancertype/Lymphomanon-Hodgkins/TypesofNHL/Smalllymphocytic
  [5] Warrell D et al. Oxford Textbook of Medicine. 4nd ed. Oxford; Oxford University Press; 2003.