Small Lymphocytic Lymphoma SLL Treatment Stages Prognosis Everyday Health MenuNewslettersSearch Lymphoma Small Lymphocytic Lymphoma SLL Treatment Stages Prognosis By Julie Lynn MarksMedically Reviewed by Conor Steuer, MDReviewed: September 19, 2022Medically ReviewedSmall lymphocytic lymphoma (SLL) is a type of cancer that happens when your body makes too many abnormal versions of a type of white blood cell called B lymphocytes. When normal, B lymphocytes help fight infection. If you have SLL, these lymphocytes build up and grow in your lymph nodes, which are small, oval glands spread throughout the body that filter harmful substances out of your body through the lymphatic system. There are two main types of lymphoma: Hodgkin and non-Hodgkin. SLL is a type of non-Hodgkin lymphoma. It’s a lot like chronic lymphocytic leukemia (CLL) and is treated the same way. The only difference between them is where they occur. When the cancer cells are mostly found in the lymph nodes, it’s called SLL. In the case of CLL, the cancer cells are generally located in the bloodstream and bone marrow, but they may also be present in the spleen and lymph nodes. For the cancer to be considered CLL, you must have at least 5,000 monoclonal lymphocytes (per cubic millimeter, or mm3) in your blood. For the cancer to be called SLL, you must have enlarged lymph nodes or an enlarged spleen with fewer than 5,000 lymphocytes (per mm3) in your blood. SLL and CLL are usually slow-growing and may not need to be treated immediately. These cancers primarily affect older people. (1,2,3) Most Recent in Cancer News Standing Up for Better Lung Cancer Care New Guidelines Recommend Best Uses of Acupuncture Massage and Other Non-Drug Treatments for Cancer Pain Immunotherapy Given Before Target Therapy Improves Advanced Melanoma Survival Rates Types of Melanoma What Are the Symptoms of Small Lymphocytic Lymphoma SLL might not cause symptoms early on. Some people with this type of cancer never have any symptoms at all. They only learn that they have the disease when it is detected in a routine blood test. If you do experience symptoms, the first sign of SLL is usually swelling in the lymph nodes in the neck, armpit, or groin. Other symptoms may include:FeverNight sweatsWeight lossLoss of appetiteFrequent infectionsFatigueShortness of breathEasy bruisingA swollen abdomenFeeling of fullness after only eating a small amount of food (4,5) How Is Small Lymphocytic Lymphoma Diagnosed Doctors commonly diagnose SLL by performing a biopsy. This procedure involves removing all or part of a lymph node and sending the sample to a lab to check for cancer. Other tests that may be used to help your doctor learn more about the cancer include:A physical exam (to check for enlarged lymph nodes or an enlarged spleen)Blood testsX-raysImaging tests, such as a computerized tomography (CT) scanBone marrow sampling Both CLL and SLL are managed and treated the same way. (6) Editor s Picks A Consumer s Guide to Clinical Trials Diet and Cancer What You Need to Know — and Eat — to Feel Your Best While Fighting Cancer CAR T-Cell Therapy Enhances the Human Immune Response to Cancer Speaking Cancer A Glossary of Formal and Informal Terms Used to Describe Cancer Tests Treatment Patients and More What Are the Causes and Risk Factors of Small Lymphocytic Lymphoma Like many cancers, doctors aren’t sure exactly what causes SLL. They do know that it’s not infectious and can’t be spread from one person to another. Certain risk factors may raise your chances of developing the cancer. These include:Being Older The most common age at which people are diagnosed with SLL is 65.Being Male Men are slightly more likely to get SLL and CLL than women.Having a Close Family Member With the Disease You’re a little more likely to develop lymphoma if you have a parent or sibling who had it.Having Other Medical Conditions Being diagnosed with rheumatoid arthritis, human immunodeficiency virus (HIV), Sjögren’s syndrome, lupus, or other cancers can increase your risk of developing lymphoma. Some viruses and infections can also up your odds. (7) Stages of Small Lymphocytic Lymphoma After you’re diagnosed with SLL, your doctor will perform certain tests to find out how advanced the cancer is and if it has spread to different parts of your body. This is known as staging the cancer. Staging lymphoma can help your physician recommend the most effective treatment approaches. Most types of non-Hodgkin lymphoma are staged with a system called the Lugano classification. It involves using the numbers 1 through 4 to categorize the cancer. If the lymphoma is a stage 1 or 2 but affects an organ outside the lymph system, it might also have a letter “E” added to the stage description. Here’s a breakdown of each stage:Stage 1 The cancer is only found in one lymph node area or lymphoid organ.Stage 1E The lymphoma is found in only one area of a single organ outside the lymphatic system.Stage 2 The cancer is in two or more groups of lymph nodes on the same side of the diaphragm.Stage 2E The lymphoma is found in a group of lymph nodes and one area of a nearby organ. It might also be present in other groups of lymph nodes on the same side of the diaphragm.Stage 3 The cancer is found in lymph node areas on both sides of the diaphragm, or it’s in lymph nodes above the diaphragm and in the spleen.Stage 4 The lymphoma has spread to at least one organ outside the lymph system, such as the liver or lung. If the cancer affects the blood or bone marrow, it’s often staged differently, using a system for CLL. (8) Most Popular Articles in Lymphoma New Targeted Therapy Approved for Adults With Mantle Cell Lymphoma FDA Approves CAR T-Cell Therapy for Some Cases of B-Cell Lymphoma New Study Sheds Light on Genetic Differences in Types of Lymphoma After the Cure Survival Rates for Lymphomas Are High but Patients Need to Consider Long-Term Effects Treatment Options for Small Lymphocytic LymphomaTreatment for SLL will depend on your symptoms, your age, the stage of the cancer, and your overall health. Active Surveillance If you have few or no symptoms, your doctor might decide not to treat the lymphoma right away. This is known as “active surveillance” or “watchful waiting.” Studies have shown that people with less advanced disease who follow an active surveillance approach have similar outcomes as those who are treated early on. With active surveillance, your physician will monitor the cancer and your overall health with regular checkups and tests. Treatment can be started if you develop symptoms or if tests show the cancer is progressing. (4) Treatments If your doctor recommends treatment, you may receive one medicine or a combination of different drugs. In some cases, these therapies may be given as part of a clinical trial. Or you might need a medical procedure to treat the cancer. Before starting any treatment, your doctor should do genetic tests on your cancer cells to identify specific abnormalities or mutations. This information can help your physician recommend the best treatment for you. Options for SLL generally include:Chemotherapy Chemotherapy medicines can be given orally or through an injection into a vein. Some chemotherapy drugs for SLL are: cyclophosphamide (Cytoxan), fludarabine (Fludara), chlorambucil (Leukeran), pentostatin (Nipent), bendamustine (Bendeka), and lenalidomide (Revlimid). These drugs are often used in combination with each other or with another type of medicine.Monoclonal Antibodies These medicines use the body’s natural immune system to fight cancer. They’re typically administered by an injection and are often given along with chemotherapy or another type of drug. Monoclonal antibodies that are used for SLL may include: rituximab (Rituxan), alemtuzumab (Lemtrada), obinutuzumab (Gazyva), and ofatumumab (Arzerra).Targeted Treatments These therapies attack different targets on cancer cells. Ibrutinib (Imbruvica) and idelalisib (Zydelig) are examples of targeted treatments for SLL. Both of these medicines are pills that are taken by mouth and are sometimes used with other therapies. Other targeted treatments include acalabrutinib (Calquence), which may be used when the cancer has not responded to other drugs, and venetoclax (Venclexta), which is sometimes used for patients 75 years old or older or for adults who can’t be given standard chemotherapy drugs.Steroids Steroids may be used to destroy cancer cells or treat autoimmune issues in people with SLL or CLL.Radiation Radiation therapy uses high energy rays to destroy cancer cells. It’s occasionally used in people with SLL.Bone Marrow Transplant A bone marrow transplant, also called a “stem cell transplant,” may be an option for some people with SLL. It involves collecting stem cells from the blood or bone marrow of the patient or a matched donor. These cells are given back to the patient to restore damaged bone marrow after they receive high doses of chemotherapy, which wipe out the remaining bone marrow in their body. Because it can be hard on your body, a bone marrow transplant is often only performed on healthy, younger people.Splenectomy Surgery to remove the spleen doesn’t treat SLL itself, but some people might need to have it if they develop complications. (9,10,11) Complications SLL can hinder your immune system and make it more difficult for you to fight infections. Sometimes the disease causes your immune system to attack itself, and you may develop life-threatening conditions. Autoimmune hemolytic anemia (AIHA) happens when your immune system attacks your red blood cells. Immune thrombocytopenic purpura (ITP) occurs when your immune system targets the platelets in your blood. Both of these conditions may require immediate medical care. It is also possible for SLL or CLL to transform into a more aggressive form of lymphoma. (9) Clinical Trials Researchers are investigating many new therapies for SLL. If the disease is very advanced or doesn’t respond to current treatments, your doctor might recommend that you enroll in a study. Participating in a clinical trial may allow you to receive certain investigational therapies that aren’t yet available to the public. You can find out more about clinical trials by visiting the Leukemia and Lymphoma Society’s website or ClinicalTrials.gov. Remission Relapse and Refractory Disease After treatment for SLL, you may go into remission, which means there are no signs of cancer in your body. During this time, your doctor will continue to monitor your health. You might need to have certain tests, such as blood draws or CT scans, to periodically check for cancer. SLL often recurs, which means it returns after successful treatment. If this happens, you and your healthcare provider will come up with new treatment approaches. The word “refractory” means that the lymphoma doesn’t respond to treatments or the response doesn’t last very long. Your doctor might recommend different medicines or a clinical trial if the cancer become refractory. (12,13) Questions to Ask Your Doctor After being diagnosed with SLL, you’ll probably have a lot of questions for your doctor. Here are some you might want to ask:What stage is the lymphoma?Where is the cancer in my body?How fast is the lymphoma growing?Do you recommend treatment? Why or why not?What would happen if I didn’t have any treatment at all?What kind of side effects will the treatment cause?How can I stay healthy during treatment?Will I have to stop certain activities while receiving treatment?Are there any clinical trials I should consider?What is the outlook for this cancer?How will I know if the cancer relapses?What will my follow-up care involve?Where can I find support? (14) Coping With Small Lymphocytic Lymphoma Getting a cancer diagnosis can be scary. You may be able to help yourself cope by:Learning More About Cancer The American Cancer Society, the Leukemia and Lymphoma Society, and the Lymphoma Research Foundation offer credible information about lymphoma.Joining a Support Group In-person or online support groups can help you connect with others who have the same type of cancer.Exercising Being physically active may improve your health and make you feel better overall. Yoga and meditation can also reduce stress levels and make you feel calmer.Asking for Help Having a strong support system might help you cope with cancer. Ask family and friends for help when you need it. (15) Prognosis of Small Lymphocytic Lymphoma SLL is typically a slow-growing cancer. Many people live for years without needing any treatment. According to the National Cancer Institute, about 87.5 percent of people with SLL or CLL survive five or more years after diagnosis. (16) It’s important to know that survival statistics are only averages and can’t predict any one person’s outcome. Your prognosis will depend on several factors, including how advanced the cancer is, your overall health, and the treatments you’re given. Resources We LoveLeukemia and Lymphoma SocietyLymphoma Research FoundationLeukaemia FoundationNEWSLETTERS Sign up for our Cancer Care Newsletter SubscribeBy subscribing you agree to the Terms of Use and Privacy Policy. Editorial Sources and Fact-Checking NCI Dictionary of Cancer Terms: Small Lymphocytic Lymphoma. National Cancer Institute.Small Lymphocytic Lymphoma (SLL). Macmillan Cancer Support. March 1, 2021.How Is Chronic Lymphocytic Leukemia Staged? American Cancer Society. May 10, 2018.Chronic Lymphocytic Leukaemia (CLL) and Small Lymphocytic Lymphoma (SLL). Lymphoma Action.Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma. Lymphoma Research Foundation.Zelenetz AD, Gordon LI, Wierda WG, et al. Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma. Journal of the National Comprehensive Cancer Network. 2015.Causes and Risk Factors of Non-Hodgkin Lymphoma (NHL). Macmillan Cancer Support. March 1, 2021.Non-Hodgkin Lymphoma Stages. American Cancer Society. August 1, 2018.Small Lymphocytic Lymphoma. Leukaemia Foundation. June 23, 2021.Getting the Facts: Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma [PDF]. Lymphoma Research Foundation. February 2018.Stem Cell Transplant for Chronic Lymphocytic Leukemia. American Cancer Society. May 10, 2018.Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma: Long-Term Survivorship. Lymphoma Research Foundation.What Happens if Lymphoma Relapses? Lymphoma Action. February 2020.Questions to Ask Your Medical Team About Lymphoma. Lymphoma Action. August 2020.Coping With Non-Hodgkin Lymphoma. CancerCare. December 1, 2016.Cancer Stat Facts: NHL — Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CLL/SLL). National Cancer Institute.Additional SourcesNCCN Guidelines for Patients: Chronic Lymphocytic Leukemia [PDF]. National Comprehensive Cancer Network. 2022.Clinical Trials: Lymphoma. Leukemia & Lymphoma Society. Find a Study. ClinicalTrials.gov.Leukaemia (Leukemia) Diagnosis. Macmillan Cancer Support. 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