Causes and risk factors
Follicular lymphoma represents the second most common lymphoma in Western countries and 30-35% of all non-Hodgkin's lymphomas (class I accounts for 20-25%, class II - for 5-10%, and class III – for 5%). It can emerge in the third and fourth decades, but the average age is around 60, with a predominance in men.
Causes and risk factors are unclear. Possible etiological causes may be related to known environmental factors, such as exposure to ionizing radiation, chemical agents, or medications.
Accumulation of lymphocytes in the bone marrow can cause a decrease in hemoglobin and platelet levels, while accumulation in the lymph nodes, spleen, and liver leads to enlargement of these organs.
Which are the symptoms?
Very often the diagnosis is associated with the appearance of the following clinical manifestations:
- enlarged superficial and deep lymph nodes;
- enlarged spleen (splenomegaly) and liver (hepatomegaly);
- bone marrow damage;
- localization of pathological lymphocytes in different organs.
At any time during the illness, patients may experience:
- unexplained weight loss (>10% in the last 6 months);
- night sweating;
- body temperature above 38°C (for 2 weeks if there is no infection);
- recurrent infections.
Occasionally and infrequently, an increase in the number of circulating lymphocytes (leukemic phase of the disease) may be observed during laboratory examination.
How is it diagnosed?
How is it treated?
Asymptomatic patients with a stable increase in lymph node size over time and no decrease in hemoglobin or platelets are not immediately treatable, but require periodic outpatient monitoring, even over many years. When patients develop symptoms (either at diagnosis or during follow-up examinations) (for example, appearance of general symptoms, anemia, thrombocytopenia, massive lymphadenopathy, increased spleen size, etc.), treatment, consisting of both radiotherapy and pharmacological approach with the use of chemotherapy and immunotherapy (monoclonal antibodies) should be started. Drugs used (individually or in combination) depend mainly on the age of patients. In a case of very aggressive disease (class IIIb) or recurrent disease, radioimmunotherapy up to stem cell transplantation (autologous or from a compatible donor) may be considered.