OVERVIEW
Overview of Follicular Lymphoma
Follicular lymphoma is a tumor that originates in the cells of the lymphoid follicular germinal center.
Insured or not
Yes
Department
Oncology, Hematology
Clinical Symptoms
It may manifest as painless lymph node enlargement in the neck, armpit and groin.
Hazards
The vast majority of patients have inert disease course, some patients have recurrent relapses and may transform into diffuse large B-cell lymphoma.
Examination
Bone marrow examination, imaging examination, pathologic examination.
Diagnosis
Based on the manifestation of painless lymph node enlargement, combined with histopathologic examination, the diagnosis can be made.
Treatment principle
Comprehensive treatment based on systemic therapy.
Curability
Most of them cannot be cured.
Dietary advice
Diet should be high in calories, high in protein, rich in vitamins, easily digestible food, and drink plenty of water.
Causes
Epidemiology
Mostly seen in middle-aged and elderly people, with onset around 60 years of age.
Etiology
The onset of the disease is related to gene mutation.
Symptoms and Diagnosis
Typical Symptoms
The most common manifestation is painless lymph node enlargement, which may involve extra-nodal systems and organs. Advanced patients may also have systemic symptoms such as fever, night sweats and weight loss.
Diagnostic basis
1. The lesion is follicular, or at least partially follicular, and may have diffuse areas.
2. Relatively uniform follicles “back to back”.
3. The tumor may infiltrate the lymph node peritoneum, perilymph node blood vessels, and surrounding adipose tissue.
4. Characteristics of tumor follicles: composed of centrocytes and different numbers of centroblasts, thinning or disappearance of the condyloma, disappearance of the polar direction of the follicle, lack of phagocytes for phagocytosis of debris, and low nuclear schizoactivity in the follicle.
5. Immunohistochemistry: CD19, CD20, CD22, CD79a positive, CD10 often positive, inter-follicular tumor cells also often positive for CD10, CD5, CD43, CD23 negative, intra-follicular lymphocytes bcl-2 positive.
Treatment
Treatment policy
Comprehensive treatment based on systemic therapy.
Radiotherapy
1. Chemotherapy
Rituximab can be combined with conventional chemotherapy.
2.Radiotherapy
For patients with limited lesions or large masses, local radiotherapy can be considered.
Other treatments
Hematopoietic stem cell transplantation can be considered for patients with recurrence or malignant transformation.
Prognosis
The majority of patients have an inert course. Those with malignant transformation have a poor prognosis.
Questions you may have
Recent Breakthroughs in Follicular Lymphoma Treatment
There are two recent breakthroughs in the treatment of follicular lymphoma: the optimization of first-line therapeutic regimens and the development of new drugs for relapsed refractory follicular lymphoma.
1. Optimization of first-line treatment options
(1) Cure for early-stage patients: 95% CR rate and 96% overall remission rate after treatment with otuzumab combined with lenalidomide.
(2) Delayed progression in late stage: with rituximab maintenance therapy, the overall survival rate of patients was significantly extended to 10.5 years.
2. Relapsed refractory follicular lymphoma: new anti-CD20 monoclonal antibody Mosun (Moussun), anti-CD19 CAR-T cell therapy – Tisagenlecleucel (no Chinese translation yet).
If you are unfortunate enough to suffer from follicular lymphoma, you should go to the hospital for specific treatment and under the judgment of a professional doctor, and do not delay, as this may cause deterioration and development of the disease.
How is follicular lymphoma staged?
The staging of follicular lymphoma is mainly based on the scope of lesions in lymph nodes, and is divided into four stages.
Stage I: A single lymph node area (I) or a focal single lymph node outside the organ (IE) is invaded.
Stage II: invasion of two or more groups of lymph nodes on the same side of the diaphragm (II) or focal single extra-lymphoid organ and its regional lymph nodes, with or without invasion of other lymph node regions on the same side of the diaphragm (IIE).
Stage III: Simultaneous invasion of lymph node regions above and below the diaphragm (III), which may be accompanied by focal invasion of associated extra-lymphoid organs (IIIE), the spleen (IIIS), or both (IIIE+S).
Stage IV: Diffuse single or multiple extra-lymphoid organ involvement with or without associated lymph node enlargement, or isolated extra-lymphoid organ involvement with distant lymph node enlargement. If the liver or bone marrow is involved, the disease is considered stage IV even if it is limited.
Does follicular lymphoma stage 1-2 require treatment?
Follicular lymphoma stage 1-2 should be treated according to the detailed condition. If the lymphoma is incipient and asymptomatic with no tendency to develop, it can be left untreated, while if it is relapsed or there is a tendency for the disease to develop, it needs to be treated.
1. Follicular lymphoma is a type of non-Hodgkin’s lymphoma, which is characterized by its less invasiveness, belongs to a kind of inert lymphoma, and the destruction of lymph node tissues is relatively mild. Early stage of follicular lymphoma may have no symptom, and it is recommended to observe this case and have regular rechecks, and it does not need to be given special treatment.
2. If the follicular lymphoma is of relapsed type or there are obvious signs of development of follicular lymphoma, it is recommended to actively treat it, and clinically, the symptoms caused by follicular lymphoma can be controlled by chemotherapy. Specific drugs include cyclophosphamide, vincristine, rituximab and so on.
Specific treatment should be carried out under the guidance of physicians.
Nursing care
Daily care
1. Maintain regular life, exercise properly to improve body resistance.
2. Pay attention to personal hygiene, change underwear frequently.
3. Go out for sunbathing, but should not be over-exposed to the sun.
4. Avoid contact with poisonous and harmful substances, strive to be environmentally friendly in room decoration, use cell phones and computers correctly, and control ionizing radiation in the permissible range.
5. Learn how to check the lymph nodes and observe the changes in the superficial lymph nodes.
6. Pay attention to climate change, prevent and actively treat viral infections.
7. Regularly review the condition and consult the doctor if there is any discomfort.
Dietary management
Strengthen nutrition, provide high-calorie, high-protein, vitamin-rich and easy-to-digest food, and drink more water to promote the excretion of toxins. Encourage patients to eat fluids, and those with severe dysphagia should be fed nasogastric or intravenous supplemental nutrition. Stop smoking and drinking.