NCCN Guidelines for Patients® | Follicular Lymphoma Grade 1-2

18 NCCN Guidelines for Patients ® : Follicular Lymphoma, Grade 1–2, 2017 2 Treatment planning Blood tests LDH LDH ( l actate d e h ydrogenase) is a protein that is in most cells. It gets into your blood when a cell is damaged. Thus, a high level of LDH is a sign of cell damage. High levels can be caused by cancer or other health problems. If related to cancer, high levels may be a sign that treatment may be needed now or soon. Beta-2 microglobulin Beta-2 microglobulin is a small protein made by many types of cells, including lymphoma cells. It is measured with a blood chemistry test. If related to cancer, high levels may be a sign that treatment may be needed now or soon. Hepatitis testing Hepatitis B and C can be important factors in the treatment of follicular lymphoma. Hepatitis B can become active again due to the cancer or some of its treatments. Hepatitis C may limit how well cancer treatment works. Thus, tell your treatment team if you’ve ever been infected with hepatitis. If you’re unsure, ask your treatment team if you should get tested. Uric acid Some people with follicular lymphoma are at risk for TLS ( t umor l ysis s yndrome). This syndrome can be life threatening. It occurs when the waste released by dead cells is not quickly cleared out of your body. This results in kidney damage and severe blood electrolyte disturbances. Tumor lysis syndrome can occur among people with follicular lymphoma who are undergoing strong cancer treatments. The cancer treatment kills many cancer cells. In turn, too much tumor cell waste is released within in a short period of time. Your doctors may want to know your uric acid level before starting treatment. You may be given certain medications that can help prevent tumor lysis syndrome. Also, drinking plenty of water throughout chemotherapy can help. Ask your treatment team for more information. Antibody testing Antibodies (also called immunoglobulins) are proteins that are made by B-cells. B-cells release antibodies into the blood to protect you from viruses and bacteria. There are three major types of antibodies in blood—IgG, IgA, and IgM. Some people with follicular lymphoma have low levels of antibodies before cancer treatment. They may be sick often. The low levels may even further drop during cancer treatment. Testing of antibodies can help your doctors know if you need treatment to prevent or cure an infection. Testing will also show whether you will need immunoglobulin replacement therapy. Quantitative immunoglobulins Quantitative immunoglobulins is a test that measures the amount of each type of antibody. It requires a blood sample. Testing will show if the level of any type of antibody is too high or too low. SPEP SPEP ( s erum p rotein e lectrophoresis) is a test that measures the amount of monoclonal immunoglobulins. People with follicular lymphoma sometimes have very high amounts of tumor-specific immunoglobulins. This may cause a “monoclonal” spike on the SPEP test. The antibodies in a monoclonal spike are all copies (clones) of one type of antibody. If you do not have all five types of antibodies, your body will not be able to fight illnesses well.