What Is Small Lymphocytic Lymphoma?
You may hear your doctor refer to SLL as a "non-Hodgkin's lymphoma," which is a group of cancers that affect lymphocytes.
When you have SLL, too many ineffective lymphocytes live and multiply in your lymph nodes. These are pea-sized organs in your neck, groin, armpits, and elsewhere, that are part of your immune system.
SLL tends to grow slowly. You may not have any symptoms when you're first diagnosed. A lot of people find out they have SLL when it's detected after a blood test for another reason.
If you're not having symptoms, you may not need treatment right away. Instead, your doctor will watch your health regularly and won't suggest therapy until you need it.
For some people, treatment knocks out the cancer for good, or keeps it from coming back for a long time.
It's normal to have worries and questions about any serious condition. Learn about your treatment options, and seek out family and friends for support. They can help you get through the emotional and physical challenges ahead.
You can't "catch" SLL like you do a cold or infection. It's also not passed on from parents to children.
Doctors don't know exactly what causes it. They do know, though, that the disease is rare in people under 50. The average age that people get diagnosed with the disease is 65. And it affects men more than women.
A few things are linked to a higher risk of getting SLL:
You might not have any obvious symptoms when you're diagnosed with SLL. The disease might be found during a routine blood test.
About one-third of all people with SLL live for years without having symptoms. When symptoms appear, they may include:
Getting a Diagnosis
Your doctor will do a physical exam and may ask you questions such as:
- Have you ever noticed any swelling in your neck, armpit, or groin?
- Are you often tired?
- Is your appetite down lately?
- Have you lost any weight recently?
Your doctor may also ask you to get a lymph node biopsy. This is the main test to diagnose SLL. Your doctor removes the lymph node and checks it under a microscope for signs of cancer.
Many lymph nodes are near the surface of your skin. If that's the case, your doctor will give you a shot that numbs your skin. Then they'll make a cut and remove the lymph node.
You can usually go home the same day. You'll have a small wound with a few stitches that can be removed in about a week.
Your doctor may also do two bone marrow tests -- a bone marrow aspiration and a biopsy -- to find out how advanced your cancer is. They are usually done together as part of a single procedure that removes marrow from the back of your hip bone.
For a bone marrow aspiration, your doctor first numbs the skin over your hip and the surface of the bone. They then inserts a thin needle into the bone and uses a syringe to suck out a small amount of liquid bone marrow.
Usually the doctor does the bone marrow biopsy next. They remove a small piece of bone and marrow with a slightly larger needle.
Questions for Your Doctor
- What stage is my cancer?
- Do I need treatment right now?
- What are my treatment options?
- Are there side effects to the treatments?
- How will my daily life be affected?
- What kind of follow-up care and monitoring will I need?
If you have no symptoms, your doctor might recommend "watchful waiting." During this period, they'll monitor you and start treatment if the disease starts to get worse.
If you need treatment, you have several options:
Chemotherapy. You can get various chemotherapy drugs that kill your cancer cells. The medicine comes in pill form or may be given through an IV. You may be treated with one drug or a combination.
Chemotherapy is a key treatment for SLL and can often put the disease in remission, which means you no longer have any signs of cancer, although it can return.
Monoclonal antibody therapy. These are drugs that act like man-made antibodies that specifically target cancer cells. They help your immune system destroy them. Among those available are:
- Alemtuzumab (Campath)
- Brentuximab vedotin (Adcetris)
- Ibritumomab tiuxetan (Zevalin) - this is a monoclonal antibody drug that is attached to a radioactive molecule to bring radiation to the cancer cells.
- Obinutuzumab (Gazyva)
- Polatuzumab vedotin (Polivy)
- Ofatumumab (Arzerra)
- Rituximab (Rituxan, Rituxan Hycela)
- Tafasitamab (Monjuvi)
You get them through an IV.
Radiation therapy. This uses high energy X-rays to kill cancer cells in one or two groups of lymph nodes in the same part of the body. It may be useful if you're in the earlier stages of SLL and the disease hasn't spread.
Targeted therapy. These drugs attack one or more specific targets on cancer cells. Your doctor might suggest them if you've already had another treatment that didn't work. Examples taken orally include:
- Acalabrutinib (Calquence)
- Ibrutinib (Imbruvica)
- Duvelisib (Copiktra)
- Idelalisib (Zydelig)
- Selinexor (Xpovio)
- Tazemetostat (Tazverik)
- Zanubrutinib (Brukinsa)
Those taken by IV include:
Scientists also are looking for new ways to treat SLL in clinical trials. These test new drugs to see if they are safe and if they work. They often are a way for people to try new medicine that isn't available to everyone. Your doctor can tell you if one of these trials might be a good fit for you.
Besides new drugs, another treatment that may be part of a clinical trial is a stem cell transplant.
Stem cells are in the news a lot, but usually when you hear about them they're referring to "embryo" stem cells that are used in cloning. The stem cells in a transplant are different. They live in your bone marrow and help make new blood cells.
This procedure may use your own stem cells or stem cells from a donor.
If a donor supplies them, you'll need to find one who is the right match for you, so your body doesn't reject the new stem cells, or start fighting them the way it would fight an infection.
Close relatives, such as your brother or sister, are the best chance for a good match. If that doesn't work out, you need to get on a list of potential donors from strangers. Sometimes the best chance for the right stem cells for you will be from someone who's the same race or ethnicity as you.
Before the transplant, you'll most likely need to get treated with high doses of chemo for about a week or two. Sometimes radiation therapy is also used.
When the high-dose chemo is done, you'll start the transplant. You get the new stem cells through an IV. You won't feel any pain from this, and you're awake while it’s happening.
After your transplant, it could take 2 to 6 weeks for the stem cells to multiply and start making new blood cells. During this time you may be in the hospital, or at the very least, will need to make visits every day to get checked by your transplant team. It can take 6 months to a year until the number of normal blood cells in your body gets back to what it should be.
Taking Care of Yourself
Try your best to avoid infections. Eat a healthy diet, get proper rest, and stay away from sick people. Ask your doctor about which vaccinations you should receive, such as shots to prevent flu and pneumonia.
Living with a serious illness poses many challenges, both physically and emotionally. For strength and support, surround yourself with those who care about you. They can offer comfort, as well as practical support. You may also find it helpful to talk to a professional counselor, spiritual leader, or a support group.
What to Expect
SLL tends to be a slow-growing cancer. In time, though, SLL can turn into a more aggressive type of lymphoma.
After initial treatment for SLL, many people have a period of remission, when there are no signs of active disease. The illness may not return.
But for some people, SLL does come back. If the lymphoma returns, doctors can treat you again. Treatment for disease that returns can be successful, and you may have another period of remission. This keeps your lymphoma under control for many years.
For more information on SLL, and to find out how to join support groups, visit the web site of the Leukemia & Lymphoma Society.