Finally I have found some information about Small lymphocytic lymphoma. Much of it I may have already said, and you may have read, but not as one post. I hope that those who may know someone, who is now just being told that they have SLL, or CLL, or have been told in the recent past, will tell them about this information. Please remember, that SLL can turn into SLL/CLL, which is what happened to me. Early detection of SLL is important, as there are very beneficial remedies in the early two stages.

This information is about a type of non-Hodgkin lymphoma(NHL) called small lymphocytic lymphoma (SLL). If you have been following this blog for sometime, then you have also read about chronic lymphocytic leukemia (CLL), which is a similar condition and is treated in the same way. Small lymphocytic lymphoma is a cancer of the B-cells. It is rare in people under 50 and more common in men. This lymphoma is similar to a type of leukemia called chronic lymphocytic leukemia (CLL), which is also a cancer of the B-cells. In lymphoma, the abnormal cells mainly affect the lymph nodes, but in leukemia the abnormal cells are in the blood and the bone marrow. The spleen can be affected in both conditions, as mine is.

Causes of small lymphocytic lymphoma: The causes of small lymphocytic lymphoma are unknown. It’s not infectious and cannot be passed on to other people.

Signs and symptoms: The first sign is often a painless swelling in the neck, armpit or groin that is caused by enlarged lymph nodes. Sometimes more than one group of nodes is affected. Other symptoms may include loss of appetite and tiredness. Some people have sweating at night, unexplained high temperatures (fever) and weight loss. These are known as B symptoms.

How it is diagnosed: A diagnosis is made by removing an enlarged lymph node (a biopsy) and examining the cells under a microscope. It is a very small operation and may be done under local or general anaesthetic. Biopsies may also be taken from other areas of the body. Additional tests – including blood tests, x‑rays, scans and bone marrow samples – are then used to find out more about the type of lymphoma and how far it has spread in the body. This information is used to help decide which treatment is most appropriate.

Staging and grading: The stage of non-Hodgkin lymphoma describes how many groups of lymph nodes are affected, where they are in the body and whether other organs such as the bone marrow or liver are involved.

Stage 1 One group of lymph nodes is affected. A group of lymph nodes refers to lymph nodes in one area of the body, such as in the armpit, on one side of the neck or in the groin.

Stage 2 Two or more groups of lymph nodes are affected, and they are all either above or below the diaphragm (a sheet of muscle under the lungs).

Stage 3 The lymphoma is in lymph nodes both above and below the diaphragm.

Stage 4 The lymphoma has spread beyond the lymph nodes to other organs, such as the bones, liver or lungs.

B symptoms – As well as giving each stage a number, doctors also use either the letter A or B to show whether or not you have specific symptoms (weight loss, fevers or night sweats).  If you don’t have any of these symptoms, the letter A will be added next to the stage. If you do have these symptoms, the letter B is added next to the stage.

Grading: Non-Hodgkin lymphomas are also divided into two groups; low-grade and high-grade. Low-grade lymphomas are usually slow-growing, and high-grade lymphomas grow more quickly. Small lymphocytic lymphoma is a low-grade lymphoma and usually develops very slowly. Occasionally it may change (transform) into a high-grade non-Hodgkin lymphoma, which needs more intensive treatment.

Treatment: If the lymphoma is not causing symptoms, you may not need treatment immediately. Early treatment at this stage doesn’t help people to live longer and can cause side effects. You will be seen regularly by your cancer specialist or GP (I do not recommend a GP, the best doctors to see are Hematologist/Oncologist), and treatment will be advised when you start to get symptoms. It may be some time before this happens, and some people may never need any treatment. After treatment, many people have a time with no signs of active disease, which is known as remission. If the lymphoma comes back it can be treated again. This can give another period of remission and the lymphoma can often be controlled in this way for many years.

Chemotherapy: is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It is an important treatment and can often get the lymphoma into remission. It is often given in combination with a drug called rituximab, which is a monoclonal antibody. Chemotherapy can be given as tablets or into a vein (intravenously). You may be given just one type of chemotherapy drug or you may be given two or more drugs together (combination chemotherapy).

Chemotherapy treatments for small lymphocytic lymphoma include:

  • cyclophosphamide
  • fludarabine
  • fludarabine/cyclophosphamide  (FC)
  • fludarabine/cyclophosphamide/rituximab (FCR)
  • chlorambucil

Cyclophosphamide and fludarabine can be given on their own or in combination (FC). They can be given as tablets or as an injection into a vein. Sometimes the monoclonal antibody rituximab is given with fludarabine and cyclophosphamide. This is called FCR chemotherapy.

Another commonly used treatment for small lymphocytic lymphoma is a chemotherapy drug called chlorambucil. It comes as tablets and is usually given on its own.

Monoclonal antibody therapy: are drugs that recognise, target and stick to particular proteins on the surface of cancer cells, and can stimulate the body’s immune system to destroy the cell.

Rituximab (Mabthera®) is a monoclonal antibody that may be used to treat small lymphocytic lymphoma. It’s given as a drip into a vein (intravenous infusion). It is usually given with fludarabine and cyclophosphamide (FCR).

Alemtuzumab (Campath®) is another monoclonal antibody that is sometimes used. It can be given as an intravenous infusion or as an injection under the skin (sub-cutaneous injection).

Steroids: are drugs that are often given with chemotherapy to help treat lymphomas. They also help you feel better and can reduce feelings of sickness.

Stem cell treatment (transplants): Some people with lymphoma may have treatments using their own stem cells or stem cells from a donor. Stem cells are a special type of blood cell that can make all the other types of blood cells. This treatment is not suitable for everyone and is not done routinely. Doctors take into account a person’s general health and age before recommending them. Some people have some of their own stem cells collected and stored to allow them to have higher doses of chemotherapy to destroy the lymphoma cells. After the chemotherapy, their stem cells are returned by a drip (like a blood transfusion) to help their blood cells recover from the effects of chemotherapy. This is called an autologous transplant. Some people may have treatment using stem cells from another person (a donor). This is called an allogeneic transplant.

Radiotherapy: is the use of high-energy rays to destroy cancer cells while causing as little harm as possible to the healthy cells. It may be used as a first treatment if the lymphoma cells are contained in one or two groups of lymph nodes in the same part of the body (stage 1 or 2). In some people, this may cure the lymphoma. Radiotherapy can also be used to treat lymphoma that has come back in one area of lymph nodes.

Clinical trials: New treatments for small lymphocytic lymphoma are being researched all the time. Your doctor may invite you to take part in a clinical trial to compare a new treatment against the best available standard treatment. However, I would suggest to you, that clinical trials are usually for those left with no other options, but are usually available for all who meet the qualifications. Your doctor must discuss the treatment with you and have your informed consent before entering you into a trial. Before any trial is allowed to take place, it must be approved by a research ethics committee, which protects the interests of those taking part. You may decide not to take part or to withdraw from the trial at any stage. You will then receive the best standard treatment available.

Being that small lymphocytic lymphoma is a sub-group of Non-Hodgkin lymphoma, I thought that some information here, may be helpful.

Non-Hodgkin lymphoma is a cancer of the lymphatic system. This is part of the body’s immune system and helps us fight infection. It’s made up of organs such as the bone marrow, thymus, spleen and the lymph nodes (or lymph glands). Lymph nodes are connected by a network of tiny lymphatic vessels that contain lymph fluid. There is also lymphatic tissue in other organs, such as the skin, lungs and stomach.

There are lymph nodes all over the body. As lymph fluid flows through the lymph nodes, the nodes collect and filter out anything that is harmful or that the body doesn’t need. This includes bacteria, viruses, damaged cells and cancer cells.

Lymph fluid contains cells called lymphocytes. These are a type of white blood cell that help the body fight infection and disease.

Lymphocytes start to grow in the bone marrow, which is where blood cells are made. The two main types of lymphocytes are B-cells and T-cells. B-cells mature in the bone marrow while T-cells mature in the thymus gland behind the breast bone. When they’re mature, both B-cells and T-cells help fight infections. Lymphoma is a disease in which either T-cells or B-cells grow in an uncontrolled way.

Everyone has their own way of dealing with their illness and the different emotions they experience. You may find it helpful to talk things over with family and friends, or your doctor or nurse. You can also contact cancer support specialists, or organisations like the Leukemia/Lymphoma Society, for more information and support.

I would like to thank Macmillan cancer support for the above information.

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