Lymphomas Are Like Cars

Saying, “I have lymphoma” is like saying, “I have a car.” There are numerous makes and models and body styles. Is it fast? Is it large? What kind is it? Lymphomas bear many similarities.

Take, for instance, the fast-growing lymphomas. Some of them are extremely unique, with characteristic genetic findings, which -- like the unique body style of a Formula One race car -- make them stand out and unmistakable. The Formula One car is Burkitt lymphoma, the fastest of all the lymphomas, and one with a specific chromosome mix-up, or as we call it "translocation 8-14," or t(8;14) as it abbreviated. (Note: two other variations of this car are also available -- the t(2;8) and the t(8;22) -- but they are all still the Formula One / Burkitt model.)

Other fast-growing lymphomas are far more common, such as diffuse large B cell lymphoma (DLBCL). DLBCL is like the Ford Mustang. It is common, relatively large, and loud. The tumors of DLBCL – as its name suggests – are made up of large cells and can present rather dramatically with a fast-growing lump under the skin or unexplained fevers with or without drenching night sweats. These, too, come in a few different models, some with their own specific (genetic) modifications that set them apart from the others. Mantle cell lymphoma is like the Jaguar in that it is also sleek and fast. And like the Jaguar has its characteristic emblem, mantle cell lymphoma has an unmistakable genetic translocation.

After the sports cars and race cars there are the sedans and minivans and sport utility vehicles. These are steady and reliable. These lymphomas -- like follicular lymphoma, marginal zone lymphoma, and small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL)-- are more predictable. They usually grow slowly. What does this mean? They are hard to eradicate, but they also may not require treatment right away. We often think of these as the "chronic diseases" of lymphoma. These lymphomas are found because a painless lump won't go away or because someone found a high white blood cell count and decided to explore it further. People usually don't feel much at all in terms of feeling sick and therefore treatment can be worse than the disease.

Oncologists don't often treat these slow growing varieties right away since they have a tendency to be pretty harmless. However, over time, one of the cells might take off and decide to go 150 miles per hour down the highway, and in so doing, "transform" into an aggressive lymphoma (yes, acting more like a sports car, or DLBCL). This is not overly common, but can happen. I usually tell patients that if this does happen, they will know. They will start to feel poorly with horrible, can't-get-out-of-bed-today fatigue and possibly some recurring fevers or night sweats.

This brings me, finally, to Hodgkin lymphoma. Everything up to this point has been a non-Hodgkin variety. Hodgkin lymphoma is like saying, "I have a Tesla." Under the microscope they have a unique appearance and behave differently than the non-Hodgkin varieties. We also treat most of them with completely different chemotherapies. However, just as there are now a handful of Tesla models that look different, there are also different varieties of Hodgkin lymphoma, the most common being classical Hodgkin lymphoma. These are usually curable.

So I hope this has helped you understand the way we think about lymphomas. I could go on and on about the different T cell varieties and the weird ones like primary mediastinal B cell, but they are less common and can be thought of mostly like the sports cars.

Thanks for reading.