B Cell Lymphoproliferative Disorders

Lymphoproliferative disorders, also called lymphomas, are cancers that originate in the lymphatic system. Lymphomas are subdivided into Hodgkin's lymphoma and all other lymphomas, collectively called non-Hodgkin's lymphomas (NHL). Although NHLs can originate from B-cells or T-cells, most originate from B-cells and are called B-cell lymphoproliferative disorders. There are 14 types of B-cell lymphomas, with diffuse large B-cell lymphoma and follicular lymphoma being the most common.

Symptoms

• B-cell lymphomas are characterized by enlarged lymph nodes in the neck, armpits or groin. Occasionally, lymph nodes are enlarged behind the ears or in the elbow region. Other symptoms include fever, night sweats, fatigue, loss of appetite, weight loss and rash. Because these symptoms can be seen in a variety of medical conditions, it is important to receive regular check-ups by a physician to catch the disease early.

Diagnosis

• Diagnosis is made by lymph node biopsy and blood tests to look for low white blood cell, red blood cell and platelet levels that are characteristic of B-cell lymphomas. Cytogenetic analysis, which looks at the genetic material of the cancer cells, and immunophenotyping, which determines whether the lymphoma originated from B-cells or T-cells, are also important to diagnose the specific kind of lymphoma and find the best treatment for the disease.

Staging

• Once a B-cell lymphoma is diagnosed, imaging tests--such as CT scans, MRI or PET scans, in combination with blood tests and bone marrow studies--are used to determine how widespread the disease is. The disease is localized in one lymph node region in Stage One and is in two to three nearby regions in Stage Two. Stage Three involves multiple lymph node regions in the neck, chest and abdomen, and Stage Four denotes a disease that has metastasized to the lungs, liver or bone.

Treatment

• Each type of B-cell lymphoma behaves differently, responds to treatment differently and can be unpredictable. Radiation therapy is usually only helpful in early stages when the disease is localized. The primary treatment for B-cell lymphomas is chemotherapy, and each specific disease type has its own chemotherapeutic regimen and medication cocktail. In advanced stages, chemotherapy is usually combined with total body irradiation and bone marrow or stem cell transplants to rid the body of the cancerous cells.

Diffuse Large B-cell Lymphoma

• Diffuse large B-cell lymphoma is the most common NHL. It is usually diagnosed in middle age, has no known risk factors and is fast-growing, requiring immediate treatment. The primary treatment is a chemotherapy cocktail called CHOP (which includes cyclophosphamide, doxorubicin, vincristine and prednisone) combined with Rituxan, an engineered antibody that targets cancerous B-cells for destruction. Radiation is also considered. The general five-year survival rate is over 50 percent.

Follicular Lymphoma

• Follicular lymphoma is the second most common NHL. It also affects middle-aged adults and has no known risk factors, but is slow-growing. In the early stages, some physicians suggest taking a "watch and wait" approach. The disease is particularly sensitive to radiation and chemotherapy, with positive results. A variety of chemotherapeutic cocktails are used, including CHOP. Even if the disease returns, it can usually be kept at bay with additional chemotherapy. The general five-year survival rate is estimated around 90 percent.