SMALL LYMPHOCYTIC LYMPHOMA

Small Lymphocytic Lymphoma (SLL) is a type of cancer that impacts a specific kind of white blood cell known as lymphocytes, crucial for fighting infections in your body. Doctors often classify SLL as a form of non-Hodgkin’s lymphoma, a category encompassing various lymphocyte-related cancers.

SLL manifests as an excess of ineffective lymphocytes that proliferate within your lymph nodes, small organs located in your neck, groin, and armpits, among other places, playing a vital role in your immune system. Typically, SLL progresses slowly, and you might not experience any symptoms initially. Many individuals discover they have SLL incidentally during routine blood tests conducted for unrelated reasons.

If symptoms are absent, immediate treatment might not be necessary. Instead, your doctor will monitor your health regularly and postpone therapy until it becomes necessary. For certain individuals, treatment effectively eradicates the cancer or prolongs the time before it resurfaces.

Facing a serious illness like SLL can understandably provoke worries and questions. Educate yourself about available treatment options, and lean on your loved ones for support. Their presence can help you navigate the emotional and physical hurdles that lie ahead.

Causes

SLL isn’t contagious like a cold or infection, nor is it inherited from parents.
While the exact cause remains unknown, SLL is rare in individuals under 50, typically diagnosed around age 65, and affects men more than women.
Certain factors increase the risk of developing SLL:
Having a condition that weakens the immune system, such as HIV/AIDS.
Previous exposure to chemotherapy.
Residing or working in agricultural areas, possibly due to exposure to pesticides and herbicides.

Symptoms of Small Lymphocytic Lymphoma

SLL may initially present with no noticeable symptoms and can be discovered incidentally during routine blood tests.
Approximately one-third of individuals with SLL live for years without symptoms, but when they do appear, they may include:
Painless swelling in the neck, armpit, or groin.
Loss of appetite.
Fatigue.
Night sweats.
Fever.
Weight loss.

Diagnosis of Small Lymphocytic Lymphoma

Your doctor will conduct a physical examination and inquire about symptoms.
Diagnostic procedures may include:
Lymph node biopsy: A crucial test for diagnosing SLL, involving the removal and microscopic examination of a lymph node.
Bone marrow tests: Typically performed together, including bone marrow aspiration and biopsy, to determine the cancer’s advancement.
- Bone marrow aspiration: Involves numbing the skin over the hip and extracting a small amount of liquid bone marrow using a thin needle and syringe.
- Bone marrow biopsy: Follows aspiration, where a small piece of bone and marrow is obtained with a slightly larger needle.

Small Lymphocytic Lymphoma Treatment

If you’re symptom-free, your doctor might recommend watchful waiting, where they monitor your condition closely and initiate treatment if the disease progresses.

Treatment options:

Chemotherapy:
- Various chemotherapy drugs are available to kill cancer cells, administered orally or through an IV.
- Single or combination drug regimens are utilized.
- Chemotherapy can often induce remission, halting signs of cancer, although recurrence is possible.
Monoclonal Antibody Therapy:
- These drugs mimic natural antibodies, targeting cancer cells and aiding the immune system in their destruction.
- Examples include:
  - Alemtuzumab (Campath)
  - Ibritumomab tiuxetan (Zevalin)
  - Obinutuzumab (Gazyva)
  - Polatuzumab vedotin (Polivy)
  - Ofatumumab (Arzerra)
  - Rituximab (Rituxan, Rituxan Hycela)
  - Tafasitamab (Monjuvi)
- Administered via IV.
Radiation Therapy:
- Utilizes high-energy X-rays to eliminate cancer cells in specific lymph node groups.
- Effective in earlier stages of SLL when the disease is localized.
Targeted Therapy:
- Drugs that target specific cancer cell receptors.
- Recommended if previous treatments have been ineffective.
- Oral examples include:
  - Acalabrutinib (Calquence)
  - Ibrutinib (Imbruvica)
  - Duvelisib (Copiktra)
  - Idelalisib (Zydelig)
  - Selinexor (Xpovio)
  - Tazemetostat (Tazverik)
  - Zanubrutinib (Brukinsa)
- IV examples include:
  - Belinostat (Beleodaq)
  - Bortezomib (Velcade)
  - Copanlisib (Aliqopa)
  - Romidepsin (Istodax)
Clinical Trials:
- Investigational treatments tested in clinical trials to assess safety and efficacy.
- Offer opportunities to try new medications not yet widely available.
- Your doctor can provide information on relevant trials.
- In clinical trials, another potential treatment for Small Lymphocytic Lymphoma (SLL) is a stem cell transplant

Stem cell transplant:

stem cell transplant, a procedure involving the use of stem cells from your bone marrow to produce new blood cells.Unlike the controversial “embryo” stem cells often mentioned in the media, these stem cells reside in your bone marrow and play a role in generating blood cells.

During a stem cell transplant, these cells can be sourced from your own body or from a donor. If obtained from a donor, finding a suitable match is crucial to prevent rejection by your body or immune system reactions.

Close relatives, particularly siblings, offer the best chance of a compatible match. If familial matches are unavailable, enlisting on a registry of potential donors becomes necessary. Often, the best chance of finding a suitable donor lies within individuals of the same race or ethnicity.

Before the transplant, a preparatory phase typically involves receiving high doses of chemotherapy for approximately one to two weeks, sometimes accompanied by radiation therapy. While this treatment regimen can be challenging, medications are available to mitigate side effects such as nausea and mouth sores.

The transplant procedure itself involves receiving the new stem cells intravenously, a painless process done while awake.

Following the transplant, it may take 2 to 6 weeks for the stem cells to proliferate and commence blood cell production. During this period, hospitalization or frequent visits to the transplant team for monitoring may be necessary. It may require 6 months to a year for the number of normal blood cells in your body to return to optimal levels.

Taking Care of Yourself

Prioritize infection prevention by maintaining good hygiene, eating a balanced diet, getting adequate rest, and avoiding contact with sick individuals.
Consult your doctor regarding recommended vaccinations, such as those for flu and pneumonia.

Coping with Illness

Living with a serious illness entails physical and emotional challenges. Seek support from loved ones who can provide comfort and practical assistance. Additionally, consider seeking guidance from a professional counselor, spiritual advisor, or support group.

What to Expect

SLL typically progresses slowly, but it can evolve into a more aggressive lymphoma over time.
Following initial treatment, many individuals experience a period of remission, during which the disease shows no active signs.
However, in some cases, SLL may recur. If this occurs, further treatment is available, often leading to another period of remission and long-term disease control.

Getting Support

For additional information on SLL and access to support groups, visit the website of the Leukemia & Lymphoma Society.

Questions for Your Doctor

What is the stage of my cancer?
Is immediate treatment necessary?
What treatment options are available?
What are the potential side effects of treatment?
How will treatment impact my daily life?
What follow-up care and monitoring will be required?

Sources

Leukaemia Foundation: “Small lymphocytic lymphoma (SLL).”
Leukaemia Care: “Small lymphocytic lymphoma SLL).”
Harvard Health Publications, Harvard Medical School: “Lymph Node Biopsy.”
American Cancer Society: “Chronic Lymphocytic Leukemia Overview,” “What Is non-Hodgkin Lymphoma.”
Leukemia and Lymphoma Society: “Chronic Lymphocytic Leukemia,” “Get Information and Support.”
Lymphoma Research Foundation: “CLL/SLL Overview”
MacMillan Cancer Support: “Small Lymphocytic Lymphoma,” “Tests for CLL.”