This information is about a type of non-Hodgkin lymphoma (NHL) called lymphoblastic lymphoma.
This section should ideally be read with our general information about NHL. Lymphoblastic lymphoma is treated in a similar way to acute lymphoblastic leukaemia (ALL). You can read our general information on ALL for more information.
Non-Hodgkin lymphoma (NHL) is a cancer of the lymphatic system. This is part of the body’s immune system and helps us fight infection. The lymphatic system is made up of organs such as the bone marrow, thymus, spleen, and the lymph nodes (or lymph glands). Lymph nodes are connected by a network of tiny lymphatic vessels that contain lymph fluid. There is also lymphatic tissue in other organs, such as the skin, lungs and stomach.
There are lymph nodes all over the body. As lymph fluid flows through the lymph nodes, the nodes collect and filter out anything harmful or that the body doesn't need. This includes bacteria, viruses, damaged cells and cancer cells.
Lymph fluid contains cells called lymphocytes. These are a type of white blood cell that help the body fight infection and disease.
Lymphocytes start to grow in the bone marrow, where blood cells are made. The two main types of lymphocytes are B-cells and T-cells. B-cells mature in the bone marrow, while T-cells mature in the thymus gland behind the breast bone. When they're mature, both B-cells and T-cells help fight infections.
Lymphoma is a disease where either T-cells or B-cells grow in an uncontrolled way.
There are many different types of NHL. The types are grouped (or classified) according to certain characteristics, such as the type of cell involved (B-cell or T-cell) and what they look like under a microscope. The most widely used classification system is produced by the World Health Organisation.
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Lymphoblastic lymphoma is very rare in adults and usually occurs in people under the age of 35. It's most common in children and teenagers.
It usually develops from T-cells but occasionally develops from B-cells.
Lymphoblastic lymphoma is very similar to acute lymphoblastic leukaemia (ALL). In lymphoma, the abnormal lymphocytes are generally in the lymph nodes or thymus gland, but in ALL they are mainly in the blood and bone marrow. The two conditions are often treated in very similar ways.
We have a section of information that's specifically written for teenagers and young adults with cancer, which might be helpful.
Causes of lymphoblastic lymphoma
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The causes of lymphoblastic lymphoma are unknown. It's not infectious and cannot be passed on to other people.
Signs and symptoms of lymphoblastic lymphoma
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The first sign is often a painless swelling in the neck, armpit or groin, caused by enlarged lymph nodes. The thymus gland, or the lymph nodes in the chest (mediastinal lymph nodes), are also often affected.
The lymphoma may spread to other areas of the body, such as the liver, spleen, bone marrow, skin, testicles and brain, causing specific symptoms.
Some people experience a loss of appetite and tiredness.
Other symptoms may include night sweats, unexplained high temperatures and weight loss. These are known as B symptoms.
How lymphoblastic lymphoma is diagnosed
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A diagnosis is made by removing an enlarged lymph node (a biopsy) and examining the cells under a microscope. This is a small operation and may be done under local or general anaesthetic.
Additional tests include:
a lumbar puncture to examine the cerebrospinal fluid (which protects your brain and spinal cord)
bone marrow samples.
The results of these tests are used to find out more about the lymphoma and how far it has spread in the body. This information is used to help decide which treatment is most appropriate for you.
You can read more about these tests for NHL.
Staging and grading of lymphoblastic lymphoma
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The stage of NHL describes how many groups of lymph nodes are affected, where they are in the body, and whether other organs such as the bone marrow or liver are involved. A group of lymph nodes refers to lymph nodes in one area of the body, such as in the armpit, on one side of the neck, or in the groin.
There are four stages:
One group of lymph nodes is affected.
Two or more groups of lymph nodes are affected, and all the affected lymph nodes are either above or below the diaphragm (a sheet of muscle under the lungs).
The lymphoma is in lymph nodes both above and below the diaphragm.
The lymphoma has spread beyond the lymph nodes to other organs such as the bones, liver or lungs.
As well as giving each stage a number, doctors also use either the letter A or B to show whether or not you have any of the following symptoms: weight loss, fevers or night sweats.
If you don't have any of these symptoms, the letter A is added next to the stage. If you do have these symptoms, the letter B is added next to the stage.
Sometimes the lymphoma can start in areas outside the lymph nodes. This is called extranodal lymphoma, and the stage will include the letter E (for extranodal).
For practical purposes, non-Hodgkin lymphomas are divided into two groups: indolent (sometimes called low-grade) and aggressive (sometimes called high-grade). Indolent lymphomas are usually slow‑growing, and aggressive lymphomas grow more quickly.
Lymphoblastic lymphoma is an aggressive lymphoma. This means that it is fast-growing and needs treatment straight away with chemotherapy.
Treatment for lymphoblastic lymphoma
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Chemotherapy is the main treatment for lymphoblastic lymphoma. It is usually treated more intensively than other types of lymphoma. You may be referred to a specialist centre for treatment. The treatment is similar to the treatment for ALL. Our general information about ALL has more detailed information.
Chemotherapy treatment is usually divided into three phases: induction, consolidation and maintenance. Some people also have stem cell treatment.
Chemotherapy may also be given directly into the fluid that surrounds the brain and spinal cord (known as cerebrospinal fluid).
Radiotherapy is sometimes given to the brain and spine if the lymphoma has spread.
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It can be given into a vein (intravenously), or as tablets.
This is given to destroy as many of the lymphoma cells as possible. You will be given a combination of different chemotherapy drugs weekly, usually for 10 weeks.
This is a very intense phase and you’ll need to stay in hospital for most of the time.
This is the next phase. You will have less intense doses of chemotherapy to increase the chance of destroying any remaining lymphoma cells. It is usually given over several months and you can have this as an outpatient.
Some people may have stem cell treatment.
Continuing therapy (maintenance) chemotherapy
This is given to reduce the risk of the lymphoma coming back after treatment has finished. It's a less intensive course of chemotherapy that may last for a couple of years and is given to you as an outpatient.
This is given directly into the cerebrospinal fluid. It may be used to prevent lymphoma cells from spreading into the cerebrospinal fluid, or to treat lymphoma if it has already spread there.
Radiotherapy uses high-energy rays to destroy cancer cells, while doing as little harm as possible to normal cells. Sometimes chemotherapy is combined with radiotherapy to the brain and spine if lymphoma cells are present in the cerebrospinal fluid.
Stem cell treatment (transplants)
Some people with lymphoma may have treatments using their own stem cells, or stem cells from a donor. Stem cells are a special type of blood cell that can make all other types of blood cells.
Stem cell treatment is not suitable for everyone and is not done routinely. Doctors take into account a person's general health and fitness before recommending them for this treatment.
Some people have some of their own stem cells collected and stored. This allows them to have higher doses of chemotherapy to destroy the lymphoma cells.
After the chemotherapy, their stem cells are returned by a drip (like a blood transfusion) to help their blood cells recover from the effects of chemotherapy. This is called high-dose treatment with stem cell support.
Some people may have treatment using stem cells from another person (a donor). This is called a donor (allogeneic) stem cell transplant.
Steroids are drugs that are often given with chemotherapy to help treat lymphomas. They also help you feel better and can reduce feelings of sickness (nausea).
Clinical trials for lymphoblastic lymphoma
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New treatments for lymphoblastic lymphoma are being researched all the time. Your doctor may invite you to take part in a clinical trial to compare a new treatment against the best available standard treatment. They must discuss the treatment with you and have your informed consent before entering you into a trial.
Before any trial is allowed to take place, it must be approved by a research ethics committee, which protects the interests of those taking part.
You may decide not to take part, or to withdraw from the trial at any stage. You will then receive the best standard treatment available.
Information and support
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Everyone has their own way of dealing with their illness and the different emotions they experience. You may find it helpful to talk things over with family and friends or your doctor or nurse. You can also contact our cancer support specialists or the organisations below for more information and support.
Other useful organisations
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Leukaemia CARE is a national group promoting the welfare of people with leukaemia and related blood disorders, including NHL. It has regional support groups in many counties.
The Lymphoma Association
The Lymphoma Association gives emotional support, advice and information on all aspects of NHL. It has a national network of people with lymphoma and local groups.
This section has been compiled using information from a number of reliable sources, including:
BCSH Haemato-Oncology Task Force Facilities for the Treatment of Adults with Haematological Malignancies - ‘Levels of Care’. 2010.
Bleyer A, et al. Cancer in Adolescents and Young Adults. 2007. Springer.
Lee, et al. Wintrobe’s Clinical Haematology. 12th edition. 2009. Lippincott, Williams and Wilkins.
Marcus, et al. Lymphoma - Pathology, Diagnosis and Treatment. 2007. Cambridge University Press.
Thanks to Professor Rajnish Gupta, Consultant Medical Oncologist, and the people affected by cancer who reviewed this edition. Reviewing information is just one of the ways you could help when you join our Cancer Voices network.