Small lymphocytic lymphoma

Small lymphocytic lymphoma and CLL are different manifestations of the same disease.

In SLL. the bulk of disease is in the lymph nodes, bone marrow, and other lymphoid tissues, with few, if any, abnormal lymphocytes found in the blood.

Managed in the same way as CLL.

Diagnostic work up includes CBC, chemistry panel, imaging studies, bone marrow biopsy, and quantitative immunoglobulins.

The most common B-cell non-Hodgkin’s lymphoma typically affecting elderly adults.

The condition is termed so when the tissues in various parts of the body, such as the lymph nodes, bone marrow, spleen, and liver, are affected.

Malignant lymphocytes are predominantly found in the tissues of the lymph nodes, bone marrow, spleen, and liver.

When the malignant cells are present in the peripheral blood, the condition is called chronic lymphocytic leukemia (CLL).

Cause is generally unknown, though certain genetic mutations may be involved.

Characterized by the presence of enlarged lymph nodes, spleen, and liver.

General symptoms such as fatigue, weight loss, and infections occur.

Significant pancytopenia can occur.

Initially observation, is recommended in the absence of significant symptoms.

Chemotherapy, radiation therapy, or targeted therapy may be employed in case the condition progresses.

Approximately 10% of all lymphomas are small lymphocytic lymphomas.

Generally found in elderly adults over the age of 65 years.

Average age of presentation is 60 years.

The male-female ratio is 2:1.

Occurs worldwide and all racial and ethnic groups may be affected.

Risk factors include: Advanced age, family history of immune disease, presence of any systemic disease, smoking, exposure to radiation and industrial chemicals,



X-ray, CT scan exposure.

The causative factors of Small Lymphocytic Lymphoma, a non-Hodgkin’s lymphoma, are unknown.

It may be caused by genetic mutations.

Findings of adenopathy, hepatosplenomegaly, anemia, thrombocytopenia, bruising, weight loss, fatigue, weakness, hypotension, and fever.

Many individuals may not have significant signs and symptoms early in the disease.

Associated with autoimmune disorders.which can cause joint and muscle pain, heat intolerance, recurrent rashes, abdominal pain, and a general feeling of illness.

If the brain is involved, then neurological symptoms may be observed.

If the gastrointestinal (GI) tract is involved, then GI tract symptoms may be observed.

Joint inflammation and edema can occur, if the joints are affected.

A diagnosis is performed by obtaining biopsy samples from the affected region.

Evaluation includes:

A thorough physical examination and a complete medical history.

Complete blood cell count (CBC) blood test.

Absolute lymphocyte count on peripheral blood.

Liver function blood test (LFT).

Lactate dehydrogenase (LDH) level.

Chemistry panel.

Serum calcium levels

Serum albumin levels

HIV testing

Biopsy is considered to be gold standard in arriving at a conclusive diagnosis.

Biopsy specimens are studied initially using Hematoxylin and Eosin staining, special studies, which may include immunohistochemical stains, molecular testing, flow cytometric analysis and very rarely, electron microscopic studies.

Radiological imaging may be performed to determine the extent of lymphoma:


Ultrasound scan of the affected region.

Computerized tomography (CT) scan of the affected regions

Whole body bone scan.

Whole body CT-PET scans.

Brain MRIs are used if neurological symptoms are present.

Bone marrow aspiration and biopsy is performed to determine if the bone marrow is involved.

Flow cytometry to identify cells and tp sub-classify the condition and also to detect residual levels of disease after treatment.

Flow cytometry can help in diagnosing relapse and of restart treatment as needed.

Fluorescence in situ hybridization (FISH) test may be performed on the blood or bone marrow cells to detect chromosome changes.

Immunophenotyping to identify a specific type of cell can help determine the best treatment course to be followed.

Polymerase chain reaction (PCR): It is used to measure the presence of certain biomarkers in blood or bone marrow cells, and is ultrasensitive and detects extremely low amounts of biomarkers remaining in blood, which can be missed by cytogenetic methods, such as FISH, karyotype, or flow cytometry.

PCR allows a more sensitive follow-up of patients in remission and can help determine whether additional treatment is necessary.

Complications may include:

Involvement to local and distant organs.

Hemolytic anemia


Progression to higher-grade tumors such as diffuse large B-cell lymphoma.


Staging of small lymphocytic lymphoma:

Stage 1: One group of lymph nodes are affected

Stage 2: Two or more groups of lymph nodes on one side of the diaphragm are affected.

Stage 3: Lymph nodes on both sides of the diaphragm are affected.

Stage 4: The condition involves tissues other than lymphoid tissues such as spleen, liver, and bone marrow.

During the initial stages, it may be indolent and slow-growing, asymptomatic, and may be managed by watchful waiting.

Treatment depends upon the stage, overall health, age, and type of lymphoma.

The treatment may involve the following procedures:



Stem cell transplant.

Generally a slow-growing malignancy that affects the lymph nodes, bone marrow, spleen, and liver.

With lower-stage tumors, the prognosis is usually excellent with appropriate therapy.

In higher-stage tumors, such as tumors with metastasis, the prognosis is poor

Older individuals generally have poorer prognosis than younger individuals.

Patients with small-sized tumors fare better than those with large-sized tumors.

Individuals with bulky disease have a poorer prognosis

Recurring disease associated with a worse prognosis compared to tumors that do not recur

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