When cells from the lymphoid family start to grow up, they move to other organs of the body, including the thymus, the lymph glands, and other tissues. The malignant changes of those mature cells and their uncontrolled multiplying result in the disease, which is related to leukemia, called malignant lymphoma. Some lymphomas, unlike leukemia, belong to the category of solid tumors, i.e., they are localized in a particular tissue. Lymphoma can develop slowly or can be aggressive. They are separated into two main, yet very different groups: Hodgkin’s lymphoma and non-Hodgkin’s lymphoma. A special type of malignant lymphoma concerns the mature B-lymphocytes, the cells that produce antibodies, which are called plasma cells. This disease is called multiple myeloma.
This is a disease which mainly affects the lymph glands. It spreads slowly in the beginning, with the first signs being increased lymph glands, often in the neck. Treatment may involve surgery, radiation or chemotherapy. Hodgkin’s lymphoma usually responds well to therapy and many people are cured of Hodgkin’s lymphoma, even when the disease is widely spread at the time of diagnosis. It is most common in young adults.
Malignant lymphoma (non-Hodgkin’s lymphoma)
This is a malignancy of those lymph cells which have migrated outside the bone marrow and are found in the lymph tissue. Lymphoma is found either in the lymph glands or in any of the soft tissues of the body. Lymphoma is most common in young adults. There are three types of malignant lymphoma:
- Low grade
If this lymphoma has not spread widely, then it is curable with surgery or local radiation. However, it is common to find that this lymphoma has already widely spread at the time of presentation. Patients with low grade lymphoma may not require treatment for many years and still experience long survival. There are now several new treatment techniques which may increase survival, such as monoclonal antibodies, for example MabThera, and possibly stem cell transplantation.
- Intermediate grade
This lymphoma grows faster than the low grade lymphoma. If localized, such tumors, like low grade lymphoma, are curable with radiation. Even when widespread, these lymphomas are curable in many cases with a combination of chemotherapy (sometimes high doses of chemotherapy) and stem cell transplantation.
- High grade
This lymphoma behaves like acute leukemia and is treated in a similar way, with a combination of chemotherapy, and using central nervous system prophylaxis (see treatment for acute lymphoblastic leukemia). The prognosis of this type of lymphoma will depend on the extent of the disease at presentation. Where the disease is not aggressive, chemotherapy may be curative. If the disease is aggressive at presentation, the addition of stem cell transplantation (either from the patient or a compatible relative) may be beneficial.
This is a tumor where very mature B-lymphoid cells, called plasma cells, accumulate in the body, particularly in cavities of the bones. Myeloma is a tumor of the cells which normally make antibodies and other substances that are needed to fight infection. Myeloma cells can leach calcium out of the bones and soften them. This can cause bone pain and fractures, high calcium levels in the blood, anemia and kidney failure. A combination of radiation, surgery and chemotherapy produces good responses in many patients over long periods of time, and a commonly adopted tandem approach with stem cell transplantation achieves excellent results and may prolong survival. There are additionally a number of non-cytotoxic agents which can improve bone strength and prevent fractures. Other agents, such as thalidomide, show great promise in terms of treating myeloma.