Follicular lymphoma: Difference between revisions
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{{Infobox medical condition | |||
| name = Follicular lymphoma | |||
| image = [[File:Follicular_lymphoma_--_low_mag.jpg|alt=Micrograph of follicular lymphoma]] | |||
| image_size = 250px | |||
| alt = Micrograph of follicular lymphoma | |||
| caption = Micrograph of follicular lymphoma | |||
| field = [[Hematology]] | |||
| symptoms = [[Lymphadenopathy]], [[fatigue]], [[fever]], [[night sweats]], [[weight loss]] | |||
| complications = Transformation to [[diffuse large B-cell lymphoma]] | |||
| onset = Typically in [[adulthood]] | |||
| duration = [[Chronic (medicine)|Chronic]] | |||
| types = [[Grade 1]], [[Grade 2]], [[Grade 3a]], [[Grade 3b]] | |||
| causes = [[Genetic mutations]], [[chromosomal translocations]] | |||
| risks = [[Age]], [[family history]], [[immunodeficiency]] | |||
| diagnosis = [[Biopsy]], [[immunohistochemistry]], [[flow cytometry]] | |||
| differential = [[Reactive lymphoid hyperplasia]], [[other types of lymphoma]] | |||
| prevention = None known | |||
| treatment = [[Watchful waiting]], [[chemotherapy]], [[immunotherapy]], [[radiation therapy]] | |||
| prognosis = Variable, often [[indolent]] | |||
| frequency = Common type of [[non-Hodgkin lymphoma]] | |||
}} | |||
'''Other Names: ''' | '''Other Names: ''' | ||
Lymphoma, follicular | Lymphoma, follicular | ||
=='''Definition'''== | =='''Definition'''== | ||
Follicular lymphoma is a form of [[non-Hodgkin lymphoma]] (see this term) characterized by a proliferation of B cells whose nodular structure of follicular architecture is preserved. | Follicular lymphoma is a form of [[non-Hodgkin lymphoma]] (see this term) characterized by a proliferation of B cells whose nodular structure of follicular architecture is preserved. | ||
Follicular lymphoma is located primarily in the [[lymph nodes]], but can also involve the [[spleen]], [[bone marrow]], peripheral blood and [[Waldeyer's ring]]. The skin and central nervous system are affected in rare cases. | Follicular lymphoma is located primarily in the [[lymph nodes]], but can also involve the [[spleen]], [[bone marrow]], peripheral blood and [[Waldeyer's ring]]. The skin and central nervous system are affected in rare cases. | ||
[[File:Lymphoma macro.jpg|thumb|Follicular lymphoma replacing a [[lymph node]]; the bubble-like outgrowths are enlarged follicles.]] | [[File:Lymphoma macro.jpg|left|thumb|Follicular lymphoma replacing a [[lymph node]]; the bubble-like outgrowths are enlarged follicles.]] | ||
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=='''Symptoms'''== | =='''Symptoms'''== | ||
Symptoms appear at an advanced stage of the disease and can include fever, night sweats and weight loss. At diagnosis, patients usually present with [[adenopathy]] and, in 50% of cases, [[splenomegaly]]. | Symptoms appear at an advanced stage of the disease and can include fever, night sweats and weight loss. At diagnosis, patients usually present with [[adenopathy]] and, in 50% of cases, [[splenomegaly]]. | ||
For most diseases, symptoms will vary from person to person. People with the same disease may not have all the symptoms listed. | For most diseases, symptoms will vary from person to person. People with the same disease may not have all the symptoms listed. | ||
80%-99% of people have these symptoms | 80%-99% of people have these symptoms | ||
*Fever | *Fever | ||
*Lymphoma(Cancer of lymphatic system) | *Lymphoma(Cancer of lymphatic system) | ||
| Line 29: | Line 46: | ||
*Night sweats | *Night sweats | ||
*Weight loss | *Weight loss | ||
30%-79% of people have these symptoms | 30%-79% of people have these symptoms | ||
*[[Fatigue]] | *[[Fatigue]] | ||
*Tired | *Tired | ||
*[[Splenomegaly]](Increased spleen size) | *[[Splenomegaly]](Increased spleen size) | ||
5%-29% of people have these symptoms | 5%-29% of people have these symptoms | ||
*Abnormality of the peritoneum | *Abnormality of the peritoneum | ||
*[[Lymphedema]](Swelling caused by excess lymph fluid under skin) | *[[Lymphedema]](Swelling caused by excess lymph fluid under skin) | ||
| Line 43: | Line 56: | ||
*Pleural effusion(Fluid around lungs) | *Pleural effusion(Fluid around lungs) | ||
*Skin nodule | *Skin nodule | ||
=='''Epidemiology'''== | =='''Epidemiology'''== | ||
Prevalence of follicular lymphoma is estimated at about 1/3,000. | Prevalence of follicular lymphoma is estimated at about 1/3,000. | ||
=='''Etiology'''== | =='''Etiology'''== | ||
In 85% of cases, follicular lymphomas are associated with a [[translocation]] t(14;18) (q32;q21), which activates the [[BCL2]] gene encoding the [[BCL2]] protein that is essential for some [[apoptosis]] processes. | In 85% of cases, follicular lymphomas are associated with a [[translocation]] t(14;18) (q32;q21), which activates the [[BCL2]] gene encoding the [[BCL2]] protein that is essential for some [[apoptosis]] processes. | ||
=='''Diagnosis '''== | =='''Diagnosis '''== | ||
Diagnosis is based on histological analysis of the [[adenopathy]], a [[complete blood count]], measurement of [[lactate dehydrogenase]] (LDH) and [[biopsy]] analysis of a [[lymph node]]. Examination using imagery (particularly a chest [[radiograph]]) is required. | Diagnosis is based on histological analysis of the [[adenopathy]], a [[complete blood count]], measurement of [[lactate dehydrogenase]] (LDH) and [[biopsy]] analysis of a [[lymph node]]. Examination using imagery (particularly a chest [[radiograph]]) is required. | ||
The observation of the [[translocation]] t(14;18) by [[polymerase chain reaction]] (PCR), in addition to suggested histological results, confirms the diagnosis.Differential diagnoses include chronic lymphocytic B cell leukemia, diffuse large B cell lymphoma, mantle cell lymphoma and MALT lymphoma | The observation of the [[translocation]] t(14;18) by [[polymerase chain reaction]] (PCR), in addition to suggested histological results, confirms the diagnosis.Differential diagnoses include chronic lymphocytic B cell leukemia, diffuse large B cell lymphoma, mantle cell lymphoma and MALT lymphoma | ||
According to [[World Health Organization]] (WHO) criteria, differences in the microscopically-determined morphology of these tissues can be used to diagnose and categorized FL into the following 3 Grades with grade 3 having A and B subtypes | According to [[World Health Organization]] (WHO) criteria, differences in the microscopically-determined morphology of these tissues can be used to diagnose and categorized FL into the following 3 Grades with grade 3 having A and B subtypes | ||
*Grade 1: [[follicles]] have <5 centroblasts per [[high-power field]] (hpf). | *Grade 1: [[follicles]] have <5 centroblasts per [[high-power field]] (hpf). | ||
*Grade 2: follicles have 6 to 15 centroblasts per hpf. | *Grade 2: follicles have 6 to 15 centroblasts per hpf. | ||
| Line 62: | Line 69: | ||
**Grade 3A: Grade 3 in which the follicles contain predominantly centrocytes. | **Grade 3A: Grade 3 in which the follicles contain predominantly centrocytes. | ||
**Grade 3B: Grade 3 in which the follicles consist almost entirely of centroblasts. | **Grade 3B: Grade 3 in which the follicles consist almost entirely of centroblasts. | ||
=='''Treatment'''== | =='''Treatment'''== | ||
If the lymphoma is localized it should be treated by [[radiotherapy]]. In the case of advanced stage [[lymphoma]], [[chemotherapy]] with [[immuno-chemotherapy]] should be offered ([[rituximab]] combined with CHOP). In cases of chemosensitive relapse, treatment can be intensified | If the lymphoma is localized it should be treated by [[radiotherapy]]. In the case of advanced stage [[lymphoma]], [[chemotherapy]] with [[immuno-chemotherapy]] should be offered ([[rituximab]] combined with CHOP). In cases of chemosensitive relapse, treatment can be intensified | ||
The medication(s) listed below have been approved by the Food and Drug Administration (FDA) as orphan products for treatment of this condition. | The medication(s) listed below have been approved by the Food and Drug Administration (FDA) as orphan products for treatment of this condition. | ||
*'''[[Copanlisib]]''' (Brand name: Aliqopa) For the treatment of adult patients with relapsed follicular lymphoma who have received at least two prior systemic therapies. | *'''[[Copanlisib]]''' (Brand name: Aliqopa) For the treatment of adult patients with relapsed follicular lymphoma who have received at least two prior systemic therapies. | ||
*'''[[PI3K-delta and PI3K-gamma inhibitor]]''' (Brand name: Duvelisib)PI3K-delta and PI3K-gamma inhibitor (Duvelisib) was approved for the treatment of adult patients with relapsed or refractory chronic lymphocytic leukemia (CLL), small lymphocytic lymphoma (SLL), or follicular lymphoma after at least two prior therapies. | *'''[[PI3K-delta and PI3K-gamma inhibitor]]''' (Brand name: Duvelisib)PI3K-delta and PI3K-gamma inhibitor (Duvelisib) was approved for the treatment of adult patients with relapsed or refractory chronic lymphocytic leukemia (CLL), small lymphocytic lymphoma (SLL), or follicular lymphoma after at least two prior therapies. | ||
*'''[[Obinutuzumab]]''' (Brand name: Gazyva)Indicated for the treatment of patients with follicular lymphoma (FL) who relapsed after, or are refractory to, a rituximab containing regimen. Also treatment of patients achieving at least a partial remission as well as the treatment of adult patients with previously untreated stage II bulky, II or IV follicular lymphoma. | *'''[[Obinutuzumab]]''' (Brand name: Gazyva)Indicated for the treatment of patients with follicular lymphoma (FL) who relapsed after, or are refractory to, a rituximab containing regimen. Also treatment of patients achieving at least a partial remission as well as the treatment of adult patients with previously untreated stage II bulky, II or IV follicular lymphoma. | ||
*'''[[Rituximab and hyaluronidase human]]''' (Brand name: Rituxan Hycela) Treatment of adult patients with relapsed or refractory, follicular lymphoma as a single agent, previously untreated follicular lymphoma in combination with first line chemotherapy and, in patients achieving a complete or partial response to rituximab in combination with chemotherapy, as single-agent maintenance therapy, non-progressing (including stable disease), follicular lymphoma as a single agent after first-line [[cyclophosphamide]], [[vincristine]], and [[prednisone]] (CVP) [[chemotherapy]]. | *'''[[Rituximab and hyaluronidase human]]''' (Brand name: Rituxan Hycela) Treatment of adult patients with relapsed or refractory, follicular lymphoma as a single agent, previously untreated follicular lymphoma in combination with first line chemotherapy and, in patients achieving a complete or partial response to rituximab in combination with chemotherapy, as single-agent maintenance therapy, non-progressing (including stable disease), follicular lymphoma as a single agent after first-line [[cyclophosphamide]], [[vincristine]], and [[prednisone]] (CVP) [[chemotherapy]]. | ||
=='''Prognosis'''== | =='''Prognosis'''== | ||
The survival rate at five years is 80-90% and medial survival is approximately 10-12 years. | The survival rate at five years is 80-90% and medial survival is approximately 10-12 years. | ||
{{Hematological malignancy histology}} | {{Hematological malignancy histology}} | ||
{{Chromosomal abnormalities}} | {{Chromosomal abnormalities}} | ||
{{DEFAULTSORT:Follicular Lymphoma}} | {{DEFAULTSORT:Follicular Lymphoma}} | ||
[[Category:Non-Hodgkin lymphoma]] | [[Category:Non-Hodgkin lymphoma]] | ||
{{stub}} | {{stub}} | ||
Latest revision as of 18:23, 6 April 2025
Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
Founder, WikiMD Wellnesspedia &
W8MD's medical weight loss NYC, sleep center NYC
Philadelphia medical weight loss and Philadelphia sleep clinics
| Follicular lymphoma | |
|---|---|
| Micrograph of follicular lymphoma | |
| Synonyms | N/A |
| Pronounce | N/A |
| Specialty | N/A |
| Symptoms | Lymphadenopathy, fatigue, fever, night sweats, weight loss |
| Complications | Transformation to diffuse large B-cell lymphoma |
| Onset | Typically in adulthood |
| Duration | Chronic |
| Types | Grade 1, Grade 2, Grade 3a, Grade 3b |
| Causes | Genetic mutations, chromosomal translocations |
| Risks | Age, family history, immunodeficiency |
| Diagnosis | Biopsy, immunohistochemistry, flow cytometry |
| Differential diagnosis | Reactive lymphoid hyperplasia, other types of lymphoma |
| Prevention | None known |
| Treatment | Watchful waiting, chemotherapy, immunotherapy, radiation therapy |
| Medication | N/A |
| Prognosis | Variable, often indolent |
| Frequency | Common type of non-Hodgkin lymphoma |
| Deaths | N/A |
Other Names:
Lymphoma, follicular
Definition[edit]
Follicular lymphoma is a form of non-Hodgkin lymphoma (see this term) characterized by a proliferation of B cells whose nodular structure of follicular architecture is preserved. Follicular lymphoma is located primarily in the lymph nodes, but can also involve the spleen, bone marrow, peripheral blood and Waldeyer's ring. The skin and central nervous system are affected in rare cases.
Symptoms[edit]
Symptoms appear at an advanced stage of the disease and can include fever, night sweats and weight loss. At diagnosis, patients usually present with adenopathy and, in 50% of cases, splenomegaly. For most diseases, symptoms will vary from person to person. People with the same disease may not have all the symptoms listed. 80%-99% of people have these symptoms
- Fever
- Lymphoma(Cancer of lymphatic system)
- Mediastinal lymphadenopathy(Swollen lymph nodes in center of chest)
- Night sweats
- Weight loss
30%-79% of people have these symptoms
- Fatigue
- Tired
- Splenomegaly(Increased spleen size)
5%-29% of people have these symptoms
- Abnormality of the peritoneum
- Lymphedema(Swelling caused by excess lymph fluid under skin)
- Meningitis
- Pleural effusion(Fluid around lungs)
- Skin nodule
Epidemiology[edit]
Prevalence of follicular lymphoma is estimated at about 1/3,000.
Etiology[edit]
In 85% of cases, follicular lymphomas are associated with a translocation t(14;18) (q32;q21), which activates the BCL2 gene encoding the BCL2 protein that is essential for some apoptosis processes.
Diagnosis [edit]
Diagnosis is based on histological analysis of the adenopathy, a complete blood count, measurement of lactate dehydrogenase (LDH) and biopsy analysis of a lymph node. Examination using imagery (particularly a chest radiograph) is required. The observation of the translocation t(14;18) by polymerase chain reaction (PCR), in addition to suggested histological results, confirms the diagnosis.Differential diagnoses include chronic lymphocytic B cell leukemia, diffuse large B cell lymphoma, mantle cell lymphoma and MALT lymphoma According to World Health Organization (WHO) criteria, differences in the microscopically-determined morphology of these tissues can be used to diagnose and categorized FL into the following 3 Grades with grade 3 having A and B subtypes
- Grade 1: follicles have <5 centroblasts per high-power field (hpf).
- Grade 2: follicles have 6 to 15 centroblasts per hpf.
- Grade 3: follicles have >15 centroblasts per hpf.
- Grade 3A: Grade 3 in which the follicles contain predominantly centrocytes.
- Grade 3B: Grade 3 in which the follicles consist almost entirely of centroblasts.
Treatment[edit]
If the lymphoma is localized it should be treated by radiotherapy. In the case of advanced stage lymphoma, chemotherapy with immuno-chemotherapy should be offered (rituximab combined with CHOP). In cases of chemosensitive relapse, treatment can be intensified The medication(s) listed below have been approved by the Food and Drug Administration (FDA) as orphan products for treatment of this condition.
- Copanlisib (Brand name: Aliqopa) For the treatment of adult patients with relapsed follicular lymphoma who have received at least two prior systemic therapies.
- PI3K-delta and PI3K-gamma inhibitor (Brand name: Duvelisib)PI3K-delta and PI3K-gamma inhibitor (Duvelisib) was approved for the treatment of adult patients with relapsed or refractory chronic lymphocytic leukemia (CLL), small lymphocytic lymphoma (SLL), or follicular lymphoma after at least two prior therapies.
- Obinutuzumab (Brand name: Gazyva)Indicated for the treatment of patients with follicular lymphoma (FL) who relapsed after, or are refractory to, a rituximab containing regimen. Also treatment of patients achieving at least a partial remission as well as the treatment of adult patients with previously untreated stage II bulky, II or IV follicular lymphoma.
- Rituximab and hyaluronidase human (Brand name: Rituxan Hycela) Treatment of adult patients with relapsed or refractory, follicular lymphoma as a single agent, previously untreated follicular lymphoma in combination with first line chemotherapy and, in patients achieving a complete or partial response to rituximab in combination with chemotherapy, as single-agent maintenance therapy, non-progressing (including stable disease), follicular lymphoma as a single agent after first-line cyclophosphamide, vincristine, and prednisone (CVP) chemotherapy.
Prognosis[edit]
The survival rate at five years is 80-90% and medial survival is approximately 10-12 years.
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