Aggressive follicular lymphomas are a subtype of Non-Hodgkin's Lymphomas, or NHLs. Most follicular lymphomas are indolent and grow slowly. However, they sometimes transform into more aggressive tumors. Follicular lymphomas are the second most common type of NHLs. "The Merck Manual" reports that 65,000 people are diagnosed every year with NHL in the United States.
Follicular Lymphomas
Follicular lymphomas are tumors that develop in B-cells located in lymph node follicles. B-cells synthesize and release antibodies and are an important component of the immune system. Follicular lymphomas originate in the lymph follicles, but as they become more aggressive, they may spread to the bone marrow and blood, spleen and liver. The World Health Organization divides follicular lymphomas into three grades that are characterized by the types of B-cells that make up the tumor. Tumors containing a larger percentage of large B-cells, called centroblasts, are grade three and are the most aggressive.
Transformation Risk
B-cells are rapidly proliferating cells and can acquire mutations over time that cause them to become more cancerous, a process called transformation. A study in the Journal of Clinical Oncology reported that in patients with follicular lymphoma, the risk of transformation at five 10, and 15 years after diagnosis was 17 percent, 28 percent and 37 percent, respectively.
Risk Factors
Older people and those who are immunocompromised, especially HIV-infected individuals, are at higher risk for developing NHLs. Children and young adults who develop NHLs more often have aggressive NHLs.
Symptoms
Commonly, people with follicular lymphomas display few clinically recognizable symptoms. Often lymph nodes under the arms, in the neck or groin may enlarge, but are painless. If lymph nodes enlarge in the chest and neck region, a person may become short of breath. Other symptoms include fatigue, weight loss, anemia, bruising, diarrhea and fever.
Treatment
"The Merck Manual" reports that the combination therapy of cyclophosphamide, doxorubicin, vincristine, prednisone, and the monoclonal antibody, rituximab, also known as R-CHOP, cures more than 70 percent of people with aggressive NHLs. Newer generation therapies effective in treating aggressive follicular NHLs are radioimmunotherapy and autologous and allogenic stem cell transplantation.
