Lymphoblastic Lymphoma

Lymphoblastic lymphoma (LL) is a rare type of fast-growing non-Hodgkin lymphoma (NHL). It mainly affects people under 35. It is similar to acute lymphoblastic leukaemia (ALL) and is treated in a similar way.

LL starts when white blood cells, called lymphocytes, become abnormal and grow in an uncontrolled way. The abnormal lymphocytes build up in one or more parts of the body.

The most common symptom is a painless swelling in neck, armpit or chest. Other symptoms may include:

  • breathlessness
  • cough
  • chest pain
  • night sweats
  • weight loss
  • high temperatures (fevers).

LL can affect other areas of the body. Other symptoms depend on where in the body the lymphoma is growing.

To diagnose lymphoma, a doctor removes a sample of cells (biopsy) from an affected area to be checked for abnormal cells. You will also have tests and scans to find out more about the lymphoma.

LL is treated with chemotherapy. Some people may have radiotherapy. Sometimes a stem cell transplant is used to treat LL that comes back. You may be invited to join a clinical trial looking at new ways of treating LL. You can talk about this with your lymphoma doctor.

What is lymphoblastic lymphoma?

It is best to read this information with our general information about non-Hodgkin lymphoma (NHL). If you have any more questions, you can ask your doctor or nurse at the hospital where you are having treatment.

Lymphoblastic lymphoma (LL) is a rare type of fast-growing NHL. It develops when the body makes abnormal lymphocytes. It can develop from both B-cell and T-cell lymphocytes. Lymphocytes are white blood cells that fight infection.

The abnormal lymphocytes (lymphoma cells) usually build up in lymph nodes but can affect other parts of the body.

LL is very similar to acute lymphoblastic leukaemia (ALL) and is treated in a similar way. It is most common in children and teenagers. We have more information about ALL and information written for teenagers and young adults with cancer.

We also have information about children’s cancers. For more information about lymphoma or leukaemia in children, contact the Children’s Cancer and Leukaemia Group


Causes and risk factors for LL

We don’t yet know the causes of LL. It is not infectious and cannot be passed on to other people. It is very rare in adults and usually occurs in people under the age of 35. It is more common in males than females.

We have more information about risk factors for lymphoma.


Signs and symptoms of LL

The first sign of LL is often a swelling in the neck, armpit or chest. This is caused by lymphoma cells building up in the lymph nodes, which makes them bigger. It can cause symptoms such as:

  • shortness of breath
  • cough
  • chest pain.

B symptoms

Other symptoms may include:

  • night sweats
  • unexplained high temperatures (fevers)
  • weight loss.

These are called B symptoms.

When LL affects other areas of the body

LL sometimes also affects other areas of the body, which causes other symptoms. These areas can include the:

  • bone marrow
  • brain
  • liver
  • spleen
  • skin
  • testicles
  • ovaries.


Diagnosing lymphoma

The most common test for this lymphoma is to remove part or all of an enlarged lymph node (a biopsy). This may be done under local or general anaesthetic. The biopsy is then sent to a laboratory to be checked for lymphoma cells. You may also have biopsies taken from other areas of the body.

You may have some other tests, such as:

  • blood tests
  • x-rays and scans
  • bone marrow samples
  • a lumbar puncture.

Doctors use the information from all these tests to find out more about the lymphoma, such as its stage and grade.


Staging and grading LL

The stage describes which areas of the body are affected by a lymphoma. The grade describes how the lymphoma cells look and grow.

Doctors often use information about the stage and grade to help plan lymphoma treatment. However, with LL these factors don’t affect your treatment plan.


Treating LL

Chemotherapy is the main treatment for LL. This involves several phases of treatment using different combinations of chemotherapy drugs. Sometimes stem cell treatment is used after chemotherapy.

Some people have radiotherapy as part of their treatment. This may be used to treat lymphoma in the chest or brain. Or to reduce the risk of lymphoma spreading to the brain.

If there are no signs of lymphoma after treatment, this is called remission. If lymphoma comes back, this is called recurrence or relapse.

Chemotherapy

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. LL is treated with the same type of chemotherapy as ALL. We have more detailed information about chemotherapy for ALL

You will usually have several phases of treatment using different combinations of chemotherapy drugs. Some drugs are given into a vein (intravenously). You take others as tablets. Chemotherapy may also be given directly into the fluid that surrounds the brain and spinal cord (intrathecal chemotherapy).

Treatment can take about 2 to 3 years to complete. This may sound like a long time, but most of the treatment can be given as tablets as an outpatient.

You usually have three main phases of chemotherapy:

1. Induction

The aim is to get rid of all signs of the lymphoma. This is called remission.

You usually have this phase of treatment as an inpatient and you may spend a few weeks in hospital. Some people may be able to have part of induction as an outpatient.

2. Intensification (also called consolidation)

The aim is to get rid of any remaining lymphoma cells. You will have some treatment as an inpatient, but most as an outpatient.

3. Maintenance

The aim is to reduce the risk of lymphoma coming back. You have treatment as an outpatient as it is mostly given as tablets. You will also have chemotherapy injections or lumbar punctures every few months.

Steroids

Steroids are drugs that are often given with chemotherapy to treat lymphomas. They help make chemotherapy more effective. They also help you feel better and can reduce feelings of sickness.

Radiotherapy

Radiotherapy uses high-energy rays to destroy cancer cells, while doing as little harm as possible to nearby healthy cells. Radiotherapy only treats the area of the body that the rays are aimed at.

Some people have radiotherapy as part of their treatment for LL. It may be used to treat lymphoma in the chest or brain. It is sometimes given to reduce the risk of lymphoma spreading to the brain.

Stem cell treatment (transplants)

This treatment is sometimes used to treat lymphoma that has come back after treatment. It is an intensive treatment, so it is not suitable for everyone.

Stem cells are a type of blood cell that can make all other types of blood cells. There are two different types of stem cell treatment:

High-dose treatment with stem cell support (autologous stem cell transplant)

Some people have treatment to put the lymphoma into remission. Then some of their own stem cells are collected from their blood and stored. Then they have high doses of chemotherapy to try to destroy any remaining lymphoma cells. After this, their stem cells are returned through a drip (like a blood transfusion). The stem cells help their blood cell numbers recover from the effects of chemotherapy.

Donor transplant (allogeneic transplant)

Some people have chemotherapy to put the lymphoma into remission and are then given stem cells from another person (a donor).

Clinical trials

It is common for LL to be treated as part of a clinical trial. Clinical trials test new treatments or new ways of giving treatments.

Your lymphoma doctor will explain your treatment options in detail before you make any decisions


Follow-up after treatment

After treatment, you will have regular check-ups. These appointments are a good opportunity for you to talk to your doctor or nurse about any concerns you have. Your doctor will want to know how you are feeling generally, and to check you are recovering from any side effects of treatment. We have more information about follow-up.


Getting support

Everyone has their own way of dealing with 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 call our cancer support specialists free on 0808 808 00 00. The organisations below also offer information and support:

  • Bloodwise offers support and information to people affected by blood cancers, including lymphoma.
  • The Lymphoma Association gives emotional support, advice and information on all aspects of Hodgkin lymphoma and non-Hodgkin lymphoma. It has a national network of people with lymphoma, and local groups.