What is primary bone lymphoma?
Primary bone lymphoma is a rare condition where lymphoma starts in a bone in the body. Lymphomas usually start in lymph nodes, and less commonly in other body parts like the stomach, testicles, skin, eyes and brain. But lymphomas can arise in any organ, and bones are no exception. Lymphoma that arises in nodes and other body parts can sometimes spread to the bone. This is actually a much more common situation and is called âsecondaryâ involvement of bone. It is not the same as primary bone lymphoma.
Who does it affect?
Primary lymphomas of the bone mainly affect adults. It is most common in individuals in their forties and fifties, and is nearly twice as common in males compared with females.
Symptoms of primary bone lymphoma
Most individuals affected by bone lymphoma first feel pain in their bones. This may persist for months before any other symptoms arise. When the lymphoma grows bigger, it can cause a swelling of the limb and limit movements of the arm or leg. Other symptoms of lymphoma like fever and weight loss are not common.
Tests for bone lymphoma
To diagnose a bone lymphoma, doctors need to see X-rays and scans of the bone. A tumor of the bone shows characteristic changes in the appearance of the bone on MRI or CT scans. To find out the type of tumor, it is necessary to take a biopsy from the bone. This can be done with a small surgery to take a small piece of the tumor, and its examination under the microscope.
Once the diagnosis of lymphoma is made, other tests need to be done to find out if the tumor is widespread or limited to the bone.
What type of lymphoma is it?
The most common lymphoma that affects the bone is non-Hodgkinâs lymphoma (NHL). Hodgkinâs lymphoma is much less likely to be found. Among the different types of NHL, diffuse large B-cell lymphoma (DLBCL) is the most common. The type of lymphoma decides the treatment that should be offered.
Treatment of primary bone lymphoma
Primary bone lymphoma that has not spread to other areas of the body can be often cured. Current treatment usually involves chemotherapy for a few cycles, followed by radiation therapy to the bone. Using both chemo and radiation, 80-90% of individuals can achieve a cure. Occasionally surgery, rather than radiation, may be used for some bones. Earlier, before the development of effective chemotherapy, radiation therapy was used alone. Though not as successful as combined treatment, it was able to control the tumor in more than 70% of individuals.
Principles and Practice of Radiation Oncology 4th Ed. Editors: Carlos A Perez, Luther W Brady, Edward C Halperin, and Rupert K Schmidt-Ullrich. Published by Lippincott Williams & Wilkins, 2003.
Primary bone lymphoma: treatment results and prognostic factors with long-term follow-up of 82 patients. Authors: Beal K, Allen L, Yahalom J. Published in the journal Cancer, 2006 June, Volume 106(12).