About Lymphoma > Types of Lymphoma > Follicular (Center Cell) Lymphoma

Last update: 04/30/2008

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ABOUT Lymphomas

Overview of genes and cancer

Lymphoma is a cancer

About Lymphoma - general

Characteristics
  Cell type | Histology   Grading | Staging

 Ann Arbor Staging 
  Extranodal notations  

 Diagnosis 

Host/tumor interaction and the microenvironment 

Lymphatic System

Prognostic Indicators

Risk Factors

Statistics
 
Staging
 
Symptoms
 
Transformation

 Guidelines at diagnosis
 
Treatment Decisions
 
Treatments

Watch & Wait
  

Lymphomas versus "solid" cancers

It's common to be diagnosed with lymphoma at an advanced stage (III or IV) and with bone marrow involvement. While this might seem alarming, you should know that advanced stages of lymphoma can be treated successfully, and that lymphoma in the bone marrow is as reversible as lymphoma anywhere in the body.

One way to understand this is to compare lymphoma with a so-called solid tumor, such as a prostate cancer.  Here the cell of origin does not normally exist anywhere but in the prostate. So when you find malignant prostate cells in the lymph nodes, or in the bone marrow, you have a big problem. Compare with blood cells that we expect to move anywhere in the lymphatic or circulatory system, including the nursery for these cells, the bone marrow.

Another favorable aspect of blood cancers is that they are generally much more sensitive to treatment than "solid" tumors, probably because blood cells are more poised to self- destruct, and they can also regenerate more readily from stem cells in the marrow.  Consider that the main side effect of chemotherapies is a drop in blood counts, but not the destruction of normal prostate or breast cells ...

We're not suggesting that lymphoma is not a life-threatening disease. It is. But we know that many types of lymphomas can be managed well, other types can be cured, and the potential to make additional progress against this family of diseases is real. 

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Follicular (center cell) non-Hodgkin's Lymphoma is a b-cell cancer - a b-cell is type of lymphocytes or white blood cell that normally defends you against bacteria and other types of pathogens that cause illness.

"Follicular" describes the cell type. B-cells arise from the bone marrow and mature or differentiate into many cell types that migrate to different areas of the body. Normal follicular b-cells reside in the germinal center of lymph nodes.  The majority of follicular lymphoma have an indolent (slow growing) clinical course.

B-cell stage: mature, after antigen exposure

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What is lymphoma?

Lymphomas result when damage to DNA occurs to a type of white blood cell (a lymphocyte) that results in the abnormal production of proteins that prevents the cells from dying when they should, or causes sustained rapid cell division. 

These malignant cells then may accumulate to form tumors that may enlarge the lymph nodes or spread to other areas of the lymphatic system, such as the spleen or bone marrow. 

Lymphoma cells can also migrate to, or first appear, outside the lymphatic system.  Lymphoma that presents outside the lymphatic system is called extranodal disease.  For details, see Lymphoma simplified.

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Incidence

Follicular non-Hodgkin's Lymphoma (NHL) is a very common type of b-cell lymphoma, comprising approximately 30% of all cases. There are about 61,000 new cases of NHL diagnosed annually. Therefore, there are approximately 18,300 new cases of follicular NHL diagnosed annually. Follicular lymphomas account for 70% of indolent (slow growing) lymphomas. The mean age at diagnosis is about 60 to 65 years. 

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Diagnosis   

To make an accurate diagnosis of lymphoma, a biopsy must be performed by the surgical removal (resection) of a lymph node. A fine needle aspiration may be performed if a lymph node is not accessible, but this is not considered a definitive way to determine the diagnosis.

A series of tests will then be performed to determine the characteristics of the cells. If a malignancy is determine, these characteristics will allow your doctors to determine the appropriate treatments to use when needed.  

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Staging

Staging refers to the how widespread the disease is. Imaging tests (CT MRI, PET, Gallium) and bone marrow biopsies are commonly done to estimate this. See Staging for more detail.

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Common signs and symptoms

Other symptoms may include night sweats, unexplained high temperatures and weight loss. These are known as B symptoms.

Prognostic indicators

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Resources

Subtypes of Follicular non-Hodgkin's lymphomas

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Follicular lymphomas are further categorized by cell size: "The cells of follicle center lymphomas are derived from the germinal center cells of the normal lymph node. This category in the Working Formulation encompasses three different tumor types: 

follicular predominantly small-cleaved (generally slower growing), 
 
follicular mixed small-cleaved and large-cell, and 
 
follicular predominantly large-cell (generally faster growing). 

In the Kiel classification, these tumors are included within the centroblastic/centrocytic and follicular centroblastic classifications." 
source: cancernetwork

[1375] Extranodal Follicular Lymphoma - a Retrospective Review and Comparison with Localized Nodal Follicular Lymphoma. Session Type: Poster Session 529-I - ASH 2004 | Terms of Use

Predictive signatures came from immune cells: 

" Two signatures [in follicular lymphomas] --one which indicated poor prognosis, the other good--had strong synergy and together predicted survival better than any other model tested. Unexpectedly, both came from nonmalignant immune cells infiltrating the tumors. The good prognosis signature genes reflect a mixture of immune cells that is dominated by T cells. T cells react to specific threats to the body's health. In contrast, the poor prognosis signature genes reflect a different group of immune cells dominated by macrophages and/or dendritic cells--which react to nonspecific threats--rather than T cells. - http://www.cancer.gov/newscenter/pressreleases/FollicularLymphoma 

Also see Host/tumor interaction and the microenvironment 

See more on each subtype below.

Follicular Large-Cell 

(Grade 3)

Lay comment: As tumor classification systems evolve, research using older systems may show different results than newer systems. As insights into genetic and molecular aspects of tumors are discovered it is hoped that treatment strategies more tailored to an individual's tumor will be identified. This will take research and will be facilitated by participation in research trials. - Anjou NHL-info

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TOPIC SEARCH: AshEducation | PubMed

Grade 3 Follicular lymphomas make up only a minority of all Follicular lymphomas. 

Follicular Large cell lymphomas may have a more aggressive clinical behavior, and therefore treatments may be initiated early with intend to cure or produce durable remissions.

The study suggests that most cases (roughly 85 %) previously classified as Follicular Large Cell Lymphoma would currently be classified as Follicular Grade 3a but that many of the cases currently classified as Follicular Grade 3 would not have been classified as Follicular Large Cell in the old system.  The authors of this study concluded that research regarding Follicular Large Cell should not be assumed to apply to the newer system's Follicular Grade 3. 

"Grade 3 follicular lymphoma (FL) is not a homogeneous entity (it varies), as recent cytogenetic data suggest at least two subgroups that appear to have a morphological correlate.⁷ 

Grade 3a FL with some residual centrocytes appears to represent the aggressive end of the clinical/morphological spectrum of indolent FL, closely related to grades 1 and 2 FL, and is characterized by the t(14;18). 

Grade 3b FL on the other hand is characterized by sheets of centroblasts without admixed centrocytes, is CD10-positive in only 50% of cases, is much less often associated with the t(14;18), often harbors the t(3;14) or variant involving the BCL6 oncogene and may be more closely related to de novo DLBCL. 

Cytogenetic studies suggest that within the category of grade 3b FL, the t(14;18) and t(3;14) are mutually exclusive.¹³ However, the clinical relevance of these distinctions remains controversial." -  Low-Grade Lymphoma, Hematology 2004 - Asheducationbooks

=> Compiled abstracts: Follicular grade 3 lymphoma

Resources and Reports:

Reports

Follicular Mixed-Cell

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It's common to find a mix of cell-sizes in the diagnosis of follicular lymphoma. 

Follicular Small-Cell/
Cleaved

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Most common cell-size subtype of follicular lymphoma. An indolent (slow growing) lymphoma.

Cutaneous - skin
(extranodal)

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Sometimes follicular lymphomas are first diagnosed in the skin (present there),  or spread to the skin later on.  When lymphomas that normally present in the lymphatic system moves to other areas it is called extranodal disease.  Spreading to the skin is not necessarily considered a negative prognostic indicator. 

Also see Extranodal lymphomas

Treatments

Also see

Questions for your doctor - Patients Against Lymphoma
General, Treatment, Side Effects, and Tests

Factors that determine treatment timing and approach:  

The characteristics of the lymphoma at diagnosis as determined by the pathology report, and it's actual clinical behavior, and other factors determine the type of treatment and the timing of treatment you and your doctor will consider. 

The good news is that lymphomas are often sensitive and responsive to treatments. Aggressive lymphoma are often cured, and indolent (slow growing) lymphomas are often managed effectively. Importantly, recent advances in the understanding of lymphoma has led to effective new therapies and better therapies are certain to follow.  

For indolent lymphomas, treatment is often deferred until the patient becomes symptomatic. For aggressive lymphomas treatment is typically initiated early with intent to cure.

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There is no apparent standard treatment for indolent follicular lymphomas. 
Current practices include:

TOPIC SEARCH: PubMed: Review | Therapies 
 ASCO | Medscape | FDA |  Web

General Guidelines for Indolent Lymphomas:

Related News and Resources

ClinicalTrials.gov (easy and comprehensive) searches by

Research News

Research News

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