T-Cell Lymphoma

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Definition

What is T-Cell Lymphoma?

Lymphoma is cancer that starts in the lymphocytes, a type of white blood cell of the immune system. Lymphoma is the most common kind of blood cancer. It includes both Hodgkin’s lymphoma and non-Hodgkin’s lymphoma, depending on the specific type of lymphocyte involved.

Non-Hodgkin’s lymphoma can be divided into two groups: B-cell lymphoma and T-cell lymphoma. T-cell lymphoma comes in many forms. Treatment and your general outlook depend on the type and how advanced it is at diagnosis.

One type of T-cell lymphoma is cutaneous T-cell lymphoma (CTCL). CTCL mainly affects the skin, but can also involve lymph nodes, blood, and internal organs.

The two main types are of CTCL are:

  • Mycosis fungoides. This causes a variety of lesions that can easily be mistaken for other skin conditions, such as dermatitis, eczema, or psoriasis.
  • Sézary syndrome. This is an advanced form of mycosis fungoides that also affects the blood. It can spread to lymph nodes and internal organs.

Other T-cell lymphomas are:

  • Angioimmunoblastic lymphoma. Tends to be quite aggressive.
  • Anaplastic large cell lymphoma (ALCL). Includes three subtypes. It can affect the skin, lymph nodes, and other organs.
  • Precursor T-lymphoblastic lymphoma/leukemia. Can start in the thymus and may grow in the area between the lungs.
  • Peripheral T-cell lymphoma – unspecified. A group of diseases that don’t fit other subtypes.

Rare types include:

  • Adult T-cell leukemia/lymphoma
  • Extranodal natural killer/T-cell lymphoma, nasal type
  • Enteropathy-associated intestinal T-cell lymphoma (EATL)
  • Lymphoblastic lymphoma

How common is T-Cell Lymphoma?

According to the American Cancer Society, less than 15 percent of all non-Hodgkin’s lymphomas are T-cell lymphomas. Please discuss with your doctor for further information.

Symptoms

What are the symptoms of T-Cell Lymphoma?

You may not have any signs of disease in the early stages. Symptoms vary according to the specific type of T-cell lymphoma.

Signs and symptoms of mycosis fungoides include:

  • Patches of flat, scaly skin
  • Thick, raised plaques
  • Tumors that may or may not develop into ulcers
  • Itching

Signs and symptoms of Sézary syndrome are:

  • Red, itchy rash covering most of the body, and perhaps the eyelids
  • Changes to nails and hair
  • Enlarged lymph nodes
  • Edema, or swelling

Not all forms of T-cell lymphoma cause symptoms on the skin. Other types may cause:

  • Bleeding or bruising easily
  • Recurrent infections
  • Fevers or chills with no known cause
  • Fatigue
  • Persistent abdominal pain on the left side due to swollen spleen
  • Abdominal fullness
  • Frequent urination
  • Constipation

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.

Causes

What causes T-Cell Lymphoma?

The exact cause of T-Cell Lymphoma remains unknown.

Risk factors

What increases my risk for T-Cell Lymphoma?

There are many risk factors for T-Cell Lymphoma, such as:

  • Age: Most lymphomas occur in people aged 60 years and older, but some types are more likely to affect children and young adults.
  • Sex: Some types are more likely in women, others are more likely in men.
  • Ethnicity and location: In the U.S., African-Americans and Asian-Americans are at lower risk of non-Hodgkin lymphoma than white Americans, and it is more common in developed nations.
  • Chemicals and radiation: Nuclear radiation and some chemicals used in agriculture have been linked to non-Hodgkin lymphoma.
  • Immunodeficiency: A person with a weak immune system is more at risk. This can be due, for example, to HIV ro AIDS, medications taken after an organ transplant.
  • Autoimmune disease: This is when the immune system attacks the body’s own cells. Examples include rheumatoid arthritis and celiac disease.
  • Infection: Certain viral and bacterial infections that transform lymphocytes increase the risk, such as the Epstein-Barr virus (EBV), which causes glandular fever.
  • Breast implants: These can cause anaplastic large cell lymphoma in the breast tissue.
  • Body weight and diet: Obesity has been implicated in the development of lymphoma, although more research is needed to confirm the link.

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is T-Cell Lymphoma diagnosed?

There are no routine screenings for lymphoma. If a person has persistent viral symptoms, they should see a doctor.

The doctor will ask about the patient’s personal and family medical history, and try to rule out other conditions.

They will also carry out a physical examination, including an inspection of the abdomen and chin, neck, groin, and armpits, where swellings may occur. The doctor will look out for signs of infection near lymph nodes, since this can account for most cases of swelling.

Tests will confirm whether lymphoma is present.

  • Blood tests and biopsies can detect the presence of lymphoma and distinguish between them. A biopsy involves taking a sample of lymph tissue for examination in a laboratory. The surgeon may remove a whole lymph or a part of one. In some cases, a needle can be used to take a tissue sample. A bone marrow biopsy may be necessary. This may need a local anesthetic, a sedative, or a general anesthetic. Biopsies and other tests can confirm the stage of the cancer, to see whether it has spread to other parts of the body.
  • Imaging tests such as a CT or MRI scan, X-ray imaging of the chest, abdomen, and pelvis, ultrasound scanning, or a PET scan.
  • A spinal tap, where a long, thin needle is used under local anesthetic to remove and test spinal fluid.

Staging of the cancer depends on the type, growth rate, and cellular characteristics. In stage 0 or I, the cancer is confined to a small area. In stage 4, it has spread to more distant organs.

Lymphoma can also be described as indolent, limited to one place, or aggressive, spreading to other parts of the body.

How is T-Cell Lymphoma treated?

Your treatment plan will depend on the type of T-cell lymphoma you have and how advanced it is. It’s not unusual to need more than one type of therapy.

Mycosis fungoides and Sézary syndrome may involve direct treatment on the skin as well as systemic treatment.

Skin treatments

Certain ointments, creams, and gels can be applied directly to your skin to control symptoms and even destroy cancer cells. Some of these topical treatments are:

  • Retinoids (vitamin A-derived drugs). Potential side effects are itching, irritation, and sensitivity to sunlight. Retinoids shouldn’t be used during pregnancy.
  • Long-term use of topical corticosteroids can lead to thinning of the skin.
  • Topical chemotherapy. Side effects topical chemotherapy may include redness and swelling. It can also increase the risk of other types of cancer. However, topical chemotherapy tends to have fewer side effects than oral or intravenous chemotherapies.

Systemic treatments

Medications for T-cell lymphomas include pills, injections, and those given intravenously. Targeted therapies and chemotherapy drugs are often combined for maximum effect. Systemic treatments may include:

  • A chemotherapy combination called CHOP, which includes cyclophosphamide, hydroxydoxorubicin, vincristine, and prednisone
  • Newer chemo drugs, such as pralatrexate (Folotyn)
  • Targeted drugs, such as bortezomib (Velcade), belinostat (Beleodaq), or romidepsin (Istodax)
  • Immunotherapy drugs, such as alemtuzumab (Campath) and denileukin diftitox (Ontak)

In advanced cases, you may need maintenance chemotherapy for up to two years.

Side effects of chemotherapy can include:

  • Hair loss
  • Nausea and vomiting
  • Constipation or diarrhea
  • Anemia, a shortage of red blood cells, leading to fatigue, weakness, and shortness of breath
  • Neutropenia, a shortage of white blood cells, which can leave you vulnerable to infections
  • Thrombocytopenia, a shortage of blood platelets, which makes it harder for your blood to clot

Light therapy

UVA and UVB light can kill cancer cells on the skin. Light therapy is usually given several times a week using special lamps. UVA light treatment is combined with drugs called psoralens. UVA light activates the psoralens to kill cancer cells.

Side effects include nausea and skin and eye sensitivity. UV light can raise the risk of developing other cancers later in life.

Radiation

Radiation therapy uses radioactive particles to destroy cancer cells. The beams can be directed to the affected skin so that internal organs aren’t affected. Radiation may cause temporary skin irritation and fatigue.

Extracorporeal photopheresis

This is used to treat mycosis fungoides or Sézary syndrome. In a two-day procedure, your blood will be removed and treated with UV light and drugs that activate when exposed to the light, killing cancer cells. After the blood is treated, it’ll be returned to your body.

Side effects are minimal. However, side effects may include temporary low-grade fever, nausea, dizziness, and skin redness.

Stem cell transplant

A stem cell transplant is when your bone marrow is replaced with marrow from a healthy donor. Prior to the procedure, you’ll need chemotherapy to suppress the cancerous bone marrow.

Complications can include graft failure, organ damage, and new cancers.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage T-Cell Lymphoma?

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: August 23, 2018 | Last Modified: August 23, 2018

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