B-cell lymphoma, also called B-cell non-Hodgkin lymphoma, is a type of cancer that arises in cells of the immune system. Although it can occur at any age, B-cell lymphoma is more common in older people. Different kinds of B-cell lymphoma can involve different parts of the body, affect different people, and require different treatments.
Lymphomas can be broadly categorized into two groups: Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL). B-cell lymphoma is an NHL and makes up about 85 percent of all lymphomas. B-cell lymphoma arises in a type of white blood cells known as B cells or B lymphocytes. B cells work as part of the immune system to help the body recognize and fight infection. However, genetic abnormalities can occur and cause improper multiplication of B cells, giving rise to lymphoma.
B-cell lymphoma can be further divided into multiple subtypes:
Some types of B-cell lymphoma are fast-growing cancers, also described as aggressive or high grade. Other types are slow-growing cancers (called indolent or low grade).
Diffuse large B-cell lymphoma (DLBCL) accounts for about one-quarter to one-third of all cases of non-Hodgkin lymphoma, making it the most common type of B-cell lymphoma. It generally presents as a mass in the lymph node but can also originate in other parts of the body. Based on where it forms, DLBCL might be further grouped into smaller subtypes:
DLBCL is fast-growing cancer, but when caught early enough, it is generally responsive to treatment.
Follicular lymphoma gets its name from its ability to form in circular structures called follicles. In contrast to DLBCL, follicular lymphoma is a slow-growing type of cancer and is generally not curable.
Mantle cell lymphoma (MCL) is a fast-growing disease that often forms in the gastrointestinal tract and bone marrow. It is rare and often is not diagnosed until it is in the late stages of the disease. Some cases of this type of lymphoma are much slower growing.
Chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) are two very closely related types of cancer. Both diseases have the same cancer cells originating in B cells, but SLL forms in the lymph nodes, whereas CLL forms primarily in the bone marrow and spleen.
Marginal zone lymphoma (MZL) is slow-growing cancer that can be further categorized into three distinct subtypes, depending on where the cancer forms:
MALT is the most common type of MZL. MALT occurs outside of the lymph nodes, usually in the stomach, and is often associated with infection of the bacterium Helicobacter pylori (H. pylori). NMZL occurs in the lymph nodes and bone marrow, whereas SMZL occurs in the spleen and bone marrow.
Burkitt lymphoma is an aggressive B-cell lymphoma that occurs in children as well as older adults. It is associated with Epstein-Barr virus (EBV) infection and HIV infection.
Although the name might indicate otherwise, hairy cell leukemia (HCL) is a type of B-cell lymphoma. It grows slowly and is more common in older adults, particularly in men.
Lymphoplasmacytic lymphoma, often associated with Waldenstrom macroglobulinemia, is a very rare B-cell lymphoma characterized by small lymphocytes. It is a generally slow-growing cancer that affects older adults. Due to its rarity and lack of defining features, it can typically only be diagnosed after ruling out other more common types of B-cell lymphoma.
There are many signs to watch for in B-cell lymphoma. Symptoms may include:
Talk to a doctor who can look for evidence of B-cell lymphoma if you observe some or all of these symptoms.
To confirm a diagnosis, a doctor may need to perform several tests, including some of the following:
During a physical examination, a doctor will check externally for swollen lymph nodes and confirm other disease symptoms present.
To diagnose non-Hodgkin lymphoma, a doctor performs a lymph node biopsy, in which they examine a lymph node for the presence of cancer cells. This type of test can be a surgical biopsy that involves removing an entire lymph node from the body or a needle biopsy that involves removing a portion of a lymph node. Generally, a biopsy approach that can provide some tissue for tests is preferred.
Blood tests can help the doctor check for signs of lymphoma, which may include low counts of red blood cells, white blood cells, or platelets. A urine test, although it does not directly measure indicators of lymphoma, may also be performed to analyze kidney and bladder function.
Doctors often use imaging techniques such as computed tomography (CT) scan, magnetic resonance imaging (MRI), or positron emission tomography (PET) scan to look for internal evidence of cancer. These imaging tests may be used to check for cancer cells in swollen lymph nodes and other tissues in the body.
During a bone marrow aspiration and biopsy, a doctor uses a needle to withdraw liquid from the bone marrow and to also collect a tissue sample. The samples are analyzed under a microscope to check for cancer cells.
Also known as a lumbar puncture, a spinal tap involves using a needle to collect fluid from the spinal canal. This test may be performed if there is evidence of B-cell lymphoma or a subtype of lymphoma that involves the central nervous system.
There are many treatment options available for B-cell lymphoma, including:
The type of treatment recommended varies depending on the specific subtype of B-cell lymphoma and the stage of the disease.
Chemotherapy is one of the most common forms of treatment for most forms of B-cell lymphoma. It is often administered in a combination of four specific drugs: cyclophosphamide, doxorubicin, vincristine, and prednisone. This combination of drugs is known as CHOP and is effective at treating many different forms of B-cell lymphoma.
Radiation therapy is commonly given to individuals diagnosed with early-stage disease or slow-growing cancer. It may also be given to people with fast-growing cancer who have been treated with chemotherapy.
Targeted drugs work by targeting and inhibiting a specific protein or group of proteins. They may be helpful to people who are not responding well to other treatments.
Antibiotics are often the first line of treatment for people with MALT-type marginal zone lymphoma due to its association with H. pylori infection. Drugs called proton pump inhibitors are generally used in combination with antibiotics to treat both bacterial infection and cancer.
A stem cell transplant, also called a bone marrow transplant, involves replacing the bone marrow of the person receiving treatment with that of a healthy donor. Stem cell transplantation allows the body to withstand higher doses of chemotherapy because damaged cells will be replaced. A stem cell transplant may be recommended for people in remission or those who have responded well to chemotherapy.
Immunotherapy uses the immune system to fight cancer cells. Different forms of immunotherapy might be used to treat B-cell lymphoma, including antibodies and CAR-T cell therapy.
Antibodies are proteins that recognize specific molecules, called antigens, that are present on the surface of certain cells. As part of the immune system, antibodies can bind to foreign antigens and target those cells to be destroyed. Rituximab and tafasitamab are some of the antibody drugs that have been engineered to recognize antigens on the surface of B cells, thereby specifically attacking the cancer cells. Rituximab is often used with CHOP chemotherapy in a regimen known as R-CHOP.
Chimeric antigen receptor (CAR)-T cell therapy is a newer kind of treatment. It involves removing immune cells called T cells from a person with cancer and engineering them to contain receptors, called chimeric antigen receptors, on the surface of the cells. The CAR-T cells are then modified to attack cancer and put back into the individual, where they can bind to antigens on B cells. In this way, CAR-T cell therapy uses the person’s immune system to specifically attack the cancer cells. CAR-T cell therapy may be used in people with B-cell lymphoma who have failed to respond well to other treatments.
The various subtypes of B-cell lymphoma occur in different parts of the body and have distinct underlying biology. Therefore, disease prognosis (outlook) differs depending on the particular type of disease.
Although they are aggressive diseases, fast-growing cancers such as DLBCL and Burkitt lymphoma are generally responsive to treatment, and most people can be cured.
Slow-growing cancers such as follicular lymphoma, CLL/SLL, lymphoplasmacytic lymphoma, and hairy cell leukemia (HCL) may be harder to fully cure with treatment. However, because they are slow-growing types of cancer, doctors often opt to keep an eye on progression of the disease and may or may not offer treatment. Most people can live for many years with these types of cancer.
Outcomes for people with marginal zone lymphoma can vary due to the different subtypes within the disease. MALT-type MZL, the most common, is most responsive to treatment and has higher survival rates. NMZL and SMZL are rarer and, although somewhat responsive to treatment, more research is needed to identify more effective treatments for these diseases.
Mantle cell lymphoma does not generally respond well to treatment and rates of long-term survival are low. Newer, more effective treatments are being explored to improve the survival of people living with mantle cell lymphoma.
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