Small Lymphocytic Lymphoma (SLL): Treatment Stages Prognosis

Small lymphocytic lymphoma (SLL) is a form of cancer that develops when your body produces excessive B lymphocytes, a particular type of white blood cell. B lymphocytes aid in infection resistance when they are healthy. These cells accumulate and multiply in your tiny lymph nodes or oval glands dispersed throughout your body, removing hazardous substances through the lymphatic system if you have SLL.

Hodgkin and non-Hodgkin lymphomas are the two main varieties. The non-Hodgkin lymphoma subtype SLL. It shares many similarities with chronic lymphocytic leukemia (CLL) and is handled similarly. The location of each one is the only distinction.

SLL is the term used when the lymph nodes contain most of the cancer cells. The cancer cells in CLL typically reside in the blood and bone marrow, while they can also be seen in the spleen and lymph nodes.

It takes a minimum of 5,000 monoclonal lymphocytes for a malignancy to be labelled as CLL (per mm3). Cancer is defined as SLL if a patient has an enlarged spleen or lymph nodes but less than 5,000 lymphocytes (per mm3) in the affected area.

SLL and CLL often progress slowly. Therefore early treatment may not be necessary. Older persons are particularly affected by these cancers.

Symptoms of Small Lymphocytic Lymphoma 

Early on, SLL cannot manifest any symptoms. Some people who have this type of cancer never even experience any symptoms. They are only aware of their ailment when a regular blood test reveals it.

Swelling in the lymph node areas like the armpit, neck, or groin is typically the initial symptom of SLL if you suffer any symptoms.

Additional signs can include −

• Weakness

• The unanticipated loss of weight

• Fever

• Night sweats

• Bloated, sensitive abdomen

• Feeling of fullness

• Shortness of breath

• Easy bruising

• Skin lesions

Diagnosis

By doing a biopsy on an enlarged lymph node, doctors can identify SLL. Usually, local anesthetic is administered first to numb the area. You might receive general anesthesia to sleep through the treatment if the swollen node is deep within your chest or abdomen.

The clinician may entirely or partially remove the afflicted lymph node during a biopsy. The sample is subsequently taken to a lab for analysis.

A peripheral blood smear may reveal CLL symptoms to medical professionals. This blood test examines the color, quantity, platelet, and red and white blood cell characteristics.

Other tests that may be utilized to identify SLL and CLL include −

• A physical examination to look for larger spleen or enlarged lymph nodes

• Blood tests

• X-rays, CAT scans, and other imaging tests

• Chromosome abnormality detection using fluorescence in situ hybridization (FISH)

• Biopsy and aspiration of bone marrow

• Flow cytometry detects circulating leukemia cells by analyzing cell surface markers in a patient's blood.

Blood lymphocyte counts can determine whether a patient has SLL or CLL. An enlarged lymph node or spleen and a monoclonal (cancerous) lymphocyte count in the blood of less than 5,000 per mm3 are diagnostic of SLL. A blood count of at least 5,000 monoclonal lymphocytes per mm3 is required to diagnose CLL.

Treatment

However, not all people with SLL require immediate therapy due to the gradual progression of the disease. Your doctor may advise you to "watch and wait" if no symptoms have presented themselves. This means that your doctor will keep an eye on cancer rather than actively treating cancer. But you will begin therapy if your cancer progresses or you experience symptoms. The treatment for advanced SLL is the same as that for CLL.

The following are examples of potential treatments −

Radiation Therapy

Radiation therapy is an option for treating lymphoma if it has spread to only a single lymph node. High-powered X-rays are used in radiation therapy to kill cancer cells.

Chemotherapy

While administering chemotherapy, either oral or intravenous (IV) administration is acceptable. Some medicines can specifically target cancer cells and kill them. Chlorambucil (Leukeran), fludarabine (Fludara), and bendamustine are some of the chemotherapy medications used by doctors (Treanda).

Monoclonal Antibodies

These medications aid the body's immune system in recognizing and eliminating cancer cells. Chemotherapy may occasionally be used with monoclonal antibody medications like rituximab (Rituxan, MabThera) or obinutuzumab (Gazyva).

Targeted Therapy Drugs

These medications function by inhibiting the activity of specific proteins, such as Bruton's tyrosine kinase, which promotes the expansion of lymphoma cells, and BCL-2, which contributes to the prolonged survival of lymphoma cells.

Supportive Care

Conditions like low blood count and viral or bacterial infections that may be related to the malignancy are treated with this method.

Stem cell Transplant

High-dose chemo patients may benefit from a stem cell treatment to restore bone marrow. Infections can be avoided, and a higher dose of chemotherapy can be used to kill cancer cells.

If the initial treatment prescribed by your doctor doesn't help or stops functioning, he or she may prescribe it again or recommend a different type of therapy. Inquire with your medical professional about the possibilities of enrolling in a clinical study.

Complications

The immune system can be compromised by SLL, making it harder to fend off infections. Certain diseases can trigger an immune system attack, leading to potentially fatal complications.

When the immune system mistakenly targets healthy red blood cells, the result is autoimmune hemolytic anemia (AIHA). Platelets are a kind of blood cell that are often attacked by the immune system, a condition known as immune thrombocytopenic purpura (ITP) develops. Medical attention may be necessary right away for both of these diseases.

Moreover, either SLL or CLL can progress into a more lethal malignancy.

Remission, Relapse, and Refractory Disease

Following successful SLL treatment, some patients experience complete remission. Your doctor will monitor how you are doing during this period. Testing for cancer at regular intervals may include procedures like blood samples or CT scans.

Even after effective therapy, SLL frequently recurs. You and your doctor will devise new methods of treatment if this occurs.

A refractory lymphoma does not respond to treatment or shows only temporary improvement after treatment. If cancer becomes resistant to treatment, your physician may suggest trying a new regimen or enrolling in a clinical trial.

Prognosis of Small Lymphocytic Lymphoma

In most cases, SLL progresses slowly. They can go untreated for years, which means many individuals do. Those diagnosed with SLL or CLL have a survival rate of about 87.5% at five years or longer. A person's prognosis can never be determined from survival statistics, which are just averages. Several factors will determine your prognosis, including the stage of your cancer, your general health, and the effectiveness of your treatments.