Large Cell Lymphomas (LCL) are one of the most common types of lymphoma, comprising about 20% to 30% of non-Hodgkin's lymphomas. The median age is 57, with a range of 10-88 years. Although most frequently seen in adults, large cell lymphomas are not uncommon in .
Locations
As aggressive lymphomas with a tendency to metastasize (spread to other organs), the majority eventually demonstrate some extranodal (outside the lymph nodes) component, including the gastrointestinal tract, testes, thyroid, skin, breast, central nervous system or bone. Although generally extra-nodal involvement is more common than in follicular lymphomas, the marrow is involved only about 10% of the time.
Causes
The specific cause of most forms of non-Hodgkin's lymphoma is unclear. It is possible that genetics and exposure to viral infections may increase the risk for developing this malignancy. Non-Hodgkin's lymphoma has also been linked to chemotherapy and radiation therapy as a second malignancy resulting from the treatment for certain cancers.
There has been investigation into the association of the Epstein-Barr virus (EBV) that causes the mononucleosis infection; as well as the human immunodeficiency virus (HIV), which causes acquired immune deficiency syndrome (AIDS).
Other chromosome rearrangements have been seen in non-Hodgkin's lymphoma (all types) that are also thought to promote excessive cell growth. About 20% of the cases have good evidence for a t(14;18), BCL-2 gene rearrangement. Children and adults with other hereditary abnormalities have an increased risk of developing non-Hodgkin's lymphoma, including patients with ataxia telangiectasia, X-linked lymphoproliferative disease, or the Wiskott-Aldrich syndrome.
Large Cell Lymphoma Types: A Breakdown
B Cell Lineage LCLs:
• Diffuse Large Cell Lymphoma (Cleaved / Noncleaved Cell)
• Primary Mediastinal Large B-Cell Lymphoma
• Large Cell Immunoblastic Lymphoma
• Follicular Large Cell Lymphoma - see Follicular Lymphomas
• T Cell Rich Large B Cell Lymphoma - This is a rare subtype of large B cell lymphoma which contains < 5% B cells
T Cell Lineage LCLs:
• Anaplastic Large Cell Lymphoma (ALCL)
• Other peripheral T-Cell Lymphomas
Indeterminate Origin LCLs:
These are often CD-30 positive like most anaplastic large cell lymphomas and they are often histopathologically classified with ALCLs. Treatment outcome is similar to the T-cell lymphomas.
Children
LCL accounts for about 20-25% of
childhood lymphomas.
Combined chemotherapy is standard treatment with the specific type dependent on the cell origin and stage of the disease. Radiation has not been shown to improve survival in stage I or II disease. NCI recommends all children be generally considered for clinical trials and be cared for by a multidisciplinary team of pediatric oncologists.
Resources
Personal Websites
Tony is a Large Cell NHL survivor who underwent a bone marrow transplant. He has a great site which includes the story of another large cell survivor - Tami
Reference Sources
• NCI Non-Hodgkin's Lymphoma Information
• The Hematopathology of Lymphoma - technical but full of very good information. Specific LCL information
• Frontiers in Bioscience is a source of B-cell information.
• Lymphomation.org has a very good paper pulling in all kinds of information on diffuse large cell lymphomas.
Related Articles
Non-Hodgkin's Lymphoma Information Pages:
Non-Hodgkin's Lymphomas
Non-Hodgkin's Lymphoma: Diagnosis
Non-Hodgkin's Lymphoma: Aggressive Lymphomas
Non-Hodgkin's Lymphoma: Indolent Lymphomas
Non-Hodgkin's Lymphoma: Treatment
Non-Hodgkin's Lymphoma: Resources
Bone Marrow and Stem Cell Transplants
Childhood Lymphoma Information Pages:
Childhood Lymphoma
Childhood Non-Hodgkin's Lymphoma
Childhood Non-Hodgkin's Lymphoma: Diagnosis
Childhood Non-Hodgkin's Lymphoma: Treatment
Childhood Lymphoma: Resources
Books
Non-Hodgkin's Lymphomas, Peter M. Mauch (Editor), James O. Armitage (Editor), et al., 2004.
Section IV: Pathology, Biology, Clinical Evaluation, and Treatment Section
Chapter 25: Anaplastic Large Cell Lymphoma
Chapter 27: Diffuse Large B-Cell Lymphoma
Chapter 28: Primary Mediastinal Large B-Cell Lymphoma
Living With Lymphoma, Elizabeth Adler, Oct. 2005
Large Cell Lymphoma, p. 104, pp. 337-8
