The type of cancers that affect the lymphatic system, known as lymphoma, can be either Hodgkin’s lymphoma or non-Hodgkin lymphoma, depending on the disease characteristics. Most non-Hodgkin’s lymphomas originate in the B-cells, which make them B-cell non-Hodgkin’s lymphomas, rather than T-cell lymphomas. The reasons for the development of one or the other is not completely understood, but their origin influences both prognosis and treatment.
Importance of B-Cells in Lymphoma
Non-Hodgkin’s lymphoma develops as a result of an abnormal amount of a type of white blood cells called lymphocytes. Due to lymphoma, lymphocytes do not die and give space to new ones, as they would in healthy people. Instead, they continue growing and multiplying inside the lymph nodes, leading to swelling. B-cells are responsible for combating the infections through the production of antibodies.
The different types of B-cell non-Hodgkin’s lymphoma include diffuse large B-cell lymphoma (DLBCL), the most common non-Hodgkin’s lymphoma in the U.S., estimated by the American Cancer Society to be about one in every three cases; primary mediastinal (thymic) large B-cell lymphoma, a subtype of DLBCL; follicular lymphoma, estimated in one out of five lymphomas in the U.S. by the ACS; chronic lymphocytic leukemia/small lymphocytic lymphoma; extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue; nodal marginal zone lymphoma; mantle cell lymphoma; and Burkitt lymphoma.
B-Cell Lymphoma Diagnosis
One of the most common symptoms associated with lymphoma is the presence of swollen lymph nodes, also known as lymphadenopathy. The enlarged nodes do not cause pain but may be uncomfortable and felt beneath the skin, particularly in the neck and armpits. Other symptoms include night sweats or fevers, unexplainable weight loss, or a lack of appetite. In more severe cases, patients experience difficulty breathing, pain and distention, and fatigue.
Since these symptoms can indicate a lymphoma or a series of other conditions, physicians often conduct numerous physical exams to confirm the diagnosis. A biopsy and bone marrow examination are the most common diagnostic procedures, but flow cytometry and immunohistochemical stains of the biopsied material can also be conducted, as well as thoracentesis in patients with pleural effusion and paracentesis, in cases of ascites.
Treatment of B-Cell Lymphoma
The origin of the lymphoma is crucial to determine a proper treatment. The most common treatments to address B-cell lymphoma are radiation therapy, particularly in early stages and to respond to eventual complications, curative and palliative chemotherapy, and biologic therapy. However, the treatment is usually personalized to both the stage of the disease and the type of lymphoma in question.
Follicular lymphoma is usually treated with alkylating agents and rituximab, while splenic marginal zone lymphoma is addressed with splenectomy. Extranodal B-cell lymphoma of MALT may be treated with antibiotics, surgery, or systemic chemotherapy, and mantle cell lymphoma is treated with combined chemotherapy.
Diffuse large B-cell lymphoma is treated with rituximab and cyclophosphamide, hydroxydaunorubicin, vincristine (Oncovin), prednisone, and bleomycin (R-CHOP), while mediastinal diffuse large B-cell lymphoma is treated with radiation therapy. In addition, Burkitt lymphoma may be addressed with combined chemotherapy sessions with central nervous system prophylaxis.
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