Non Hodgkin's Lymphoma


Indolent types of NHL  

On the following pages pages you will find a brief description of the various types of indolent NHL and what their particular characteristics are. In many cases we have provided links to other web sites that give more detail. Low-grade is another term that refers to indolent lymphoma.

Before discussing the individual types it is important to review some of the characteristics common to all indolent lymphomas. 

Indolent lymphomas are usually not considered curable because the cancer grows too slowly to be targeted accurately by most modern treatments. Nonetheless they actually do respond very well to treatment in most cases. People with indolent lymphomas usually survive for many years. Statistics say the median is around 10 years, but that is very misleading because the "median" only means that half the patients have not survived past 10 years, and the other half have survived. Don't try to apply a median statistic to yourself since it cannot by its very nature apply.  Suffice it to say that most patients can look forward to many years of productive life, and quite possibly a cure in the not too distant future. Rituxan, and other biologic therapies are bringing us closer all the time.

In many cases it is totally appropriate to defer treatment altogether in favour of a watch and wait approach. This is usually done when the patient has no symptoms, and there are no major organs at risk. When treatment is required there is a variety of choices, none of which has any clear advantage in all cases. The single most common chemotherapy regimen for lymphoma is CHOP and it is frequently used for indolent lymphomas, but it is also a fairly aggressive treatment which many believe should be saved for later.  Since indolent lymphomas cannot usually be cured the main goal of treatment is to keep the patient in good health as long as possible. Virtually all the low grade or indolent lymphomas are characterized by a pattern of treatment-remission-relapse with each remission being shorter than the previous one. This means using the least toxic options first, and saving the "big guns" as we call it, until later.

Click here to read an in-depth discussion of low-grade lymphoma: Biologic characteristics, pathology, treatment selection options, and transplant outcomes. This article is a comprehensive discussion by leading experts from the American Society of Hematology (ASH)

It is not unusual for some indolent cells to transform into a more aggressive form, resulting in two clones. Statistically the risk of transformation is about 30% after ten years, but this may be low since the figure is based on confirmed second biopsies, which often are not performed since the priority at such time is to treat. Historically transformation has been associated with a worse prognosis but with modern therapies this is not always the case.

Here are some articles about tranformation.

Transformation of follicular lymphoma to diffuse large-cell lymphoma

Risk and Clinical Implications of Transformation of Follicular Lymphoma to Diffuse Large B-Cell Lymphoma

There is much controversy about whether to reserve use of anthracyclines such as doxorubicin until transformation occurs. It is thought by some that the anthracyclines are the more potent drugs and should be saved until that happens, and therefore CVP or Chlorambucil should be used first. But recent studies show that upfront use of anthracyclines might actually lower the risk of transformation. Here is one such study.

The impact of initial treatment of advanced stage indolent lymphoma on the risk of transformation

Lymphoplasmacytic lymphoma (Waldenstrom macroglobulinemia)
In this type of lymphoma it is an overproduction of the immunoglobulin protein IgM by the plasma cells that produces the malignancy. This increase in paraprotein causes hyperviscosity (thickening of the blood), which can cause many problems. 

Mycosis fungoides/Sezary syndrome
This type of Lymphoma is also known as Cutaneous T-cell Lymphoma or CTCL for short. Click on the Cutaneous T-cell option on the menu to the left for more information about MF/SS or go to the link below.

Primary cutaneous anaplastic large cell lymphoma/lymphomatoid papulosis (CD30+)





Marginal Zone / MALT

Cutaneous T-cell Ask a Question

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