beta cell lymphoma | What is lymphoma?

What is lymphoma?

Prognostic factors
These are essential factors that allow to a certain extent to predict the evolution of the disease and the effectiveness of the treatment. They testify to the aggression of the disease, its extension and the ability of the patient to bear the disease or the side effects of the treatments. They are studied during the initial assessment of the disease, the most relevant of them are used to adapt the treatment.

Classic prognostic factors
They have been known for many years.

Age is obviously an essential factor. While it does not appear that the lymphomas of the elderly are very different from those of the younger ones, the ability to withstand intensive treatments is reduced with age. The treatments are therefore adapted to age and it is no longer rare to see the offer of chemotherapy to patients over 80 years.

The extension of the disease is defined by its stage. This stage is determined by the results of the initial Assessment: Clinical examination, CT, spinal biopsy, lumbar puncture and sometimes other tests.

→ are defined as four stages:

Stage I: Attainment of a single ganglion or a single organ. e.g. lymphoma of a neck ganglion or isolated stomach lymphoma
Stage II: Attainment of several lymph nodes or several organs but the disease remains limited to the lower or upper part of the body. For example, reaching the lymph nodes of the neck, armpit and mediastinum (chest ganglia) or reaching the stomach and lymph nodes of the abdomen
Stage III: Reaching the several ganglia at the lower and upper parts of the body. For example, reaching the lymph nodes of the neck and abdomen
Stage IV: disseminated organ damage. For example, reaching the bone marrow or reaching the lymph nodes of the neck and intestine
Other elements of the extension of the disease are sometimes important: particular site of the impairment (cerebral lymphoma for example), number of glands or organs affected, size of the tumor (or tumours).

The general condition of the patient at the time of diagnosis is also an important factor because it reflects his ability to bear the disease. In order to be able to quantify the general state, "performance scales" have been created. The most used is the ECOG scale that ranges from 0 to 4:

0: No reaching the general state, leads a normal life
1: There is fatigue but the patient can do most of the daily life gestures
2: Fatigue forcing the patient to lie down during the day
3: The patient stays bedridden more than half the day
4: Patient no longer rises
Simple biological tests are often used, determined on a simple blood test.

The rate of LDH (LDH) in the blood is most used. It testifies to the mass of the tumor and its aggression
The rate of beta-2-microglobulin resembles it but is less used
The level of albumin in the blood is a reflection of the general condition and in particular of the state of nutrition of the patient.
Elevation of VS (sedimentation velocity) or any other evidence of inflammation is an element of poor prognosis in Hodgkin's lymphoma
The decrease in hemoglobin levels, which translates into anemia, can be a prognostic factor

Prognostic indexes

These are combinations of prognostic factors that make it possible to establish a score whose goal is to predict the evolution of lymphoma and therefore to determine the best treatment to undertake.

The international prognostic index of large cell lymphomas: IPI

It was established from an international study conducted by the largest study groups on lymphomas from data of over 4000 patients. It is very widely used. The elements selected as the most important are:

Age (less than 60 years/over 60 years)

The rate of LDH (normal/high)

The general state (ECOG 0-1/2-4)

The stadium (I-II/III-IV)

The number of organs reached (0 or 1/More than 1)

To calculate the IPI we add the number of unfavorable factors, so it varies from 0 to 5.

The international prognostic Index of follicular lymphoma: Flipi

The elements selected as the most important are:

Age (less than 60 years/over 60 years)

The rate of LDH (normal/high)

Hemoglobin levels (> 12)

The stadium (I-II/III-IV)

The number of nodes reached (4 or less/more than 4)

New prognostic factors

Many studies have been done and are underway to look for biological factors that predict the severity of lymphoma. They deal with the genetic anomalies of lymphoma cells, the deregulation of certain genes, or the factors present in the blood. Currently none of these factors is universally recognized. It is also hoped that these markers will allow for new, more effective and specific treatments to be discovered.