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This information is about a type of non-Hodgkin lymphoma (NHL)| called lymphoblastic lymphoma.
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. It's 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.
The lymphatic system
View a large copy of the diagram of the lymphatic system|
There are lymph nodes all over the body. As lymph fluid flows through the lymph nodes, the nodes collect and filter out anything that is 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|, which is 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 in which either T-cells or B-cells grow in an uncontrolled way.
There are many different types of NHLs. They're grouped (or classified) according to certain characteristics, such as the type of cell involved (B- or T-cell) and what it looks like under a microscope. The most widely used classification system is produced by the World Health Organisation|.
Lymphoblastic lymphoma is very rare in adults and usually occurs in people under the age of 35. It's much more 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.
The causes of lymphoblastic lymphoma are unknown. It is not infectious and cannot be passed on to other people.
The first sign is often a painless swelling in the neck, armpit or groin that is 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.
A diagnosis is made by removing an enlarged lymph node (biopsy) and examining the cells under a microscope. It is a small operation and may be done under local or general anaesthetic.
Additional tests - including blood tests, x-rays, scans, a lumbar puncture| to examine the cerebrospinal fluid (which protects your brain and spinal cord), and bone marrow samples - are then 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.
We have more information about tests for non-Hodgkin lymphoma|.
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.
One group of lymph nodes is affected. 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.
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 specific symptoms. If you don't have any of these symptoms (weight loss, fevers or night sweats), the letter A will be 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, NHLs are divided into two groups; low-grade and high-grade. Low-grade lymphomas are usually slow-growing and high-grade lymphomas grow more quickly.
Lymphoblastic lymphoma is a high‑grade lymphoma. This means that it is fast‑growing and needs to be treated straight away.
Chemotherapy is the main treatment for lymphoblastic lymphoma. It is usually treated more intensively than other types of lymphoma. The treatment is similar to that of ALL|.
Chemotherapy treatment is usually divided into three phases: induction, consolidation and maintenance. Some people may 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 as a drip (infusion) or into a vein (intravenously), and sometimes as tablets.
This is given to destroy as many of the lymphoma cells as possible. You will be given a combination of many 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.
Consolidation chemotherapy
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 at a later stage after treatment has finished. It's a less intensive course of chemotherapy that may last for a couple of years and is usually given to you as an outpatient.
Intrathecal chemotherapy
This is given directly into the cerebrospinal fluid. It may be done to prevent lymphoma cells from spreading into the cerebrospinal fluid or to treat it if it has already spread.
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.
Some people with lymphoma may have treatments involving 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.
This treatment is not suitable for everyone and is not done routinely. Doctors take into account a person's general health and age before recommending them.
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 an autologous transplant.
Some people may have treatment using stem cells from another person (a donor). This is called an allogeneic 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|).
New treatments for lymphoblastic large cell 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.
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 listed below for more information and support.
This section has been compiled using information from a number of reliable sources, including:
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.