Introduction:
The lymphomas are masses of neoplastic (cancer cells) of the lymphoid tissues that undergo several mutations over the years and lose their cohesiveness. It is a cancer of the lymphocytes (a type of white blood cell). Lymphomas are cohesive tumors (solid tumors) of the immune system. Lymphoma originates from lymphoid tissue. But in immunocompromised patients such as HIV (human immunodeficiency virus), it develops in the central nervous system. In lymphomas, the immature white blood cells (hematopoietic precursor cells) from the bone marrow make a cohesive mass that settles down in various body areas.
What Are Lymphomas?
Lymphoblastic lymphomas are hematopoietic stem cells disorder of T-cell or B-cell origin. The lymphomas have more adherent molecules that stick to each other. Leukemias and lymphomas are treated as separate categories. Some lymphomas can go into the leukemic phase. So this cohesive mass spills into separate cells into the blood circulations if they lose their cohesiveness. Some leukemic cells start from a bone marrow metastasis in many tissues, and they enter into some lymphoid tissue and transform into a cohesive molecule like lymphoma. So under some circumstances, the leukemic cells change into lymphomatous masses in lymphoid tissue. So lymphomas may go into the leukemic phase and vice versa. Lymphoma is always a lymphocyte-related disease. It can be T-cell or B-cell-related lymphomas.
What Are Lymphocytes and Lymphoblastic Cells?
The hematopoietic precursor cells originate from the bone marrow and divide into different red blood cells and white blood cells. Lymphoblasts are immature white blood cells that mature into lymphocytes. Lymphocytes are white blood cells that divide into T-lymphocytes and B-lymphocytes. The lymphocytes are located in the bone marrow. The mature lymphocytes are found in the blood and the lymphatic system. The immune system is made up of lymph nodes, lymph tissue, and lymphatic organs. The lymphocytes help the body fight against infections and foreign antigens like bacteria and viruses. Lymphoblastic lymphoma develops mostly from T-lymphocytes. Sometimes they also develop from B-lymphocytes.
What Are Lymphoblastic Lymphomas?
It is a rare type of non-Hodgkin lymphoma that produces immature lymphocytes. They usually affect children and teenagers. They also occur in adults above 50 years of age.
What Are the Causes of Lymphoblastic Lymphoma?
The cause is unknown. It is not communicable and not infectious. The risk factors associated with the condition are:
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Previous infection with Epstein-Barr virus.
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Autoimmune disorder.
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Immunosuppressant medication.
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Familial history of lymphoma.
What Are the Types of Lymphoblastic Lymphoma?
The lymphoblastic lymphomas are divided into T-cell and B-cell lymphoblastic lymphomas.
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90 % of the lymphomas are T-cell lymphoblastic lymphoma. The T cells are produced from the thymus gland. It is present in the upper chest behind the sternum. Because of its location, the lymph nodes in the upper body are affected. This is known as a mediastinal mass.
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B-cell lymphoblastic lymphomas are less common than T-cell lymphoblastic lymphoma. The clinical presentation usually affects lymph nodes and tissue outside the lymph nodes.
What Are the Symptoms of Lymphoblastic Lymphoma?
The symptoms include:
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Pallor (pale appearance).
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Cough.
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Fatigue.
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Itchy skin.
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Difficulty in recovering from any infection.
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Painless swelling of the lymph nodes in the underarm, neck, and chest.
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Night sweats.
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Weight loss.
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Persistent fevers.
What Are the Diagnostic Tests Done for Lymphoblastic Lymphoma?
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A biopsy is taken. In a biopsy, a small part of the lymph node is removed and studied by a pathologist. The procedure is done under local anesthesia or general anesthesia.
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An excisional node biopsy collects an adequate amount of tissue to do the necessary testing for diagnosis.
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A bone marrow biopsy is required for diagnosis. In this procedure, the cells are collected from the bone marrow and tested by a pathologist.
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The chest X-ray images help to identify the condition.
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A PET (positron emission tomography) scan is done to understand the sites of disease in the body before the treatment starts.
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A computed tomography scan and some blood tests are done.
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Before initiating the treatment, some baseline tests such as heart scan, kidney scan, breathing test, and vitals (temperature, blood pressure, and pulse rate are tested).
What Are the Stages of Lymphoblastic Lymphoma?
The staging of the lymphoma is identified, which helps the doctor to decide on the suitable treatment. The four stages of lymphoma are:
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Early Stage- It is called localized lymphoma. In this type, the lymphoma is present in one or a few areas close together. It includes stages 1 and 2.
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Advanced Stage- In this, the lymphoma is stage 3 or 4. Nature is widespread and has spread to many parts of the body that are far from each other.
What Is the Prognosis of Lymphoblastic Lymphoma?
Most of the patients respond well to the treatment and have a very good prognosis. Younger patients have good recovery than older patients. The survival and treatment options depend upon the following factors:
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The extent of cancer.
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Age at diagnosis.
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The shape and structure of the lymphoma cells observed under the microscope.
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The lymphoma biology such as the pattern of the cells, how different the cells are from normal cells, and how fast the lymphoma cells are growing.
What Is the Treatment for Lymphoblastic Lymphoma?
Many factors are taken into consideration before deciding on the treatment plan. The doctors will meet with a team of specialists called the multidisciplinary team approach. The standard first-line chemotherapy includes:
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Hyper CVAD (the drugs are cyclophosphamide, Doxorubicin, Vincristine, Methotrexate, and Dexamethasone).
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BFM 2000 is used in young adults. The drugs include Prednisolone, Methotrexate, Vincristine, Asparaginase, Cyclophosphamide, Cytarabine, Dexamethasone, Doxorubicin, Etoposide, and Ifosfamide.
The treatment phases are:
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Induction phase, which includes multi-agent chemotherapy.
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Consolidation phase chemotherapy.
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Maintenance phase chemotherapy.
Conclusion:
Lymphoma is a cancer of the white blood cells. The treatment options have increased and improved in the past few years. Many people are alive for many years after diagnosis. If someone has the above-mentioned risk factors and symptoms, it is better to consult an oncologist or general physician to protect their health.
