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Types of Lymphoma > Aggressive versus Indolent Lymphomas
Last update: 02/01/2013
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Lymphomas are a family of blood cell cancers which are classified or grouped in many ways. This page groups lymphomas by how fast or slow they tend to grow - often referred to as the grade: high grade or low grade - but also aggressive or indolent.
When a lymphocyte becomes malignant it's maturation stage is arrested (stopped) at that stage, and it's behavior (such as fast growing, refusing to die) is determined, in part, by the behavior of it's normal counterpart.
Lymphomas are further categorized by the shape of the cells, how the cells cluster (diffuse vs. follicular), an increasingly by the genetic expression.
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Indolent Lymphomas
CLL/SLL
Chronic Lymphocytic Lymphoma
Marginal Zone:
MALT / BALT / Cutaneous
Extranodal / Eye / Splenic Follicular b-cell
most common indolent type
Waldenstrom's
Macroglobulinemia
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 TOPIC SEARCH - PubMed: Diagnosis | Review | Therapies | Prognosis
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What's New
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Hematopathology Approaches to Diagnosis and Prognosis of Indolent B-Cell Lymphomas asheducationbook.org 2005
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Generally describes low grade - slow growing-- lymphomas
Indolent lymphomas can progress steadily - behave aggressively.
Cellular Classifications
Cancer.gov
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B-cell types
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Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma
CLL/SLL
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Follicular lymphoma
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follicular small cleaved cell
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follicular mixed small cleaved and large cell
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Diffuse small cleaved cell
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Hairy-cell leukemia
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Lymphoplasmacytic lymphoma/Waldenström's macroglobulinemia
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Marginal zone - MALT (extranodal)
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Marginal zone - Nodal
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Splenic lymphoma with villous lymphocytes
(splenic marginal zone lymphoma)
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Waldenström’s Macroglobulinemia - Lymphoplasmacytic lymphoma
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T-cell types
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Mycosis fungoides/Sézary syndrome
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T-Cell CLL
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T-Cell - Large granular leukemia/lymph (T-cell/NK cell)
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Indolent Lymphomas
Treatment Resources
Treatment is often deferred until the patient becomes symptomatic. The goal of treatment is often management as indolent lymphomas are rarely cured, unless it is diagnosed when still localized. Treatment options are more varied -- there is no standard treatment.
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Treatment - Standard of care
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Indolent, Stage I and Contiguous Stage II Adult Non-Hodgkin’s Lymphoma Cancer.gov
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Indolent, Noncontiguous Stage II/III/IV Adult Non-Hodgkin’s Lymphoma Cancer.gov
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Indolent, Recurrent Adult Non-Hodgkin’s Lymphoma Cancer.gov
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Low grade Lymphoma asheducationbook.org /2004 full text
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Related Articles:
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Treatment approaches, overview for indolent and aggressive MSKCC
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Early stage localized disease? See Radiotherapy
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Lymphoma Diagnosis and Treatment: CHOP, MALT, PET, and More Medscape (free login, req.)
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Lymphomas: Lessons in Overcoming Indolence, Levine Medscape
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Follicular Lymphoma, Treatment Policy - Dr. Louise Bordeleau PDF | PDF-Help
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The Indolent Lymphomas - COMPREHENSIVE REVIEW, MEDICAL ONCOLOGY: A - Ali W. Bseiso, MD Peter McLaughlin, MD
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Treatment overview - Best Practices of Medicine for NHL & HD Merck Medicus
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Treatment Sequencing of Therapies for Low-Grade Lymphomas cancercare.org
Presenter: Peter Rosen, MD, Professor of Medicine, UCLA School of Medicine, Department of Hematology and Oncology, Los Angeles, CA.
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Watch & Wait background and treatment consideration for pts with indolent NHL
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Aggressive Lymphomas
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Related PubMed abstracts - Diagnosis | Review | Therapies | Prognosis
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Generally describes intermediate and high grade - fast growing - lymphomas
Sometimes, perhaps rarely, types of lymphomas expected to be aggressively can progress slowly - behave indolently.
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B-cell types
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Aggressive Lymphomas
Treatment Articles
Lymphoma is a type of blood cancer, and as such is rarely localized to one tumor. The cells (even if only a few) are likely to also be in adjacent lymph nodes, in the blood, and or in the bone marrow.
The good news is that as such, unlike so-called solid cancers, even wide spread disease can be treated effectively or cured with chemotherapy and radiotherapy.
The goal of treatment is to cure an aggressive lymphoma, and it is often achieved. Removing only the tumor with surgery would be under-treating the disease and would almost certainly do little to change the course of the disease.
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Treatment - Standard of care
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Adult wide spread, stage III/IV - standard of care Cancer.gov
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Adult, localized, stage I/II - standard of care Cancer.gov
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Adult, Aggressive, Recurrent Non-Hodgkin’s Lymphoma
standard of care Cancer.gov
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Autologous Stem Cell Transplantation for Relapsed Aggressive NHL
"The disease sensitivity at the time of autologous stem cell transplantation (ASCT) has remained the most significant prognostic variable for predicting treatment outcome.356 359 Several large series have shown that patients who undergo ASCT when the disease is resistant to the initial induction therapy have less than 10% probability of disease-free survival. Although many patients die of progressive lymphoma, in some studies the treatment-related mortality has been higher in this patient population (20% to 30%). Those patients in sensitive relapse have a 30% to 60% probability of long-term disease-free survival. In contrast, 10% to 20% of patients with resistant disease are long-term survivors." ncbi.nlm.nih.gov
Related Articles:
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Outcomes: Dose-escalated CHOP and Tailored Intensification with IFE According to Early Response in Poor Risk Agressive B Cell Lymphoma: A Prospective Study from the GEL TAMO Study Group. Abstract
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Antibody Therapy in Aggressive Lymphomas asheducationbook.hematologylibrary.org
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ncbi.nlm.nih.gov/
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Prophylactic intrathecal methotrexate and hydrocortisone reduces central nervous system recurrence and improves survival in aggressive non-Hodgkin lymphoma http://cat.inist.fr/
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Rituximab-CHOP-ESHAP vs CHOP-ESHAP-high-dose therapy vs conventional CHOP chemotherapy in high-intermediate and high-risk aggressive non-Hodgkin's lymphoma.
Leuk Lymphoma. 2006 Jul;47(7):1306-14. PMID: 16923561
It is concluded that rituximab-ESHAP-CHOP is superior over standard CHOP and fares comparably to upfront HDT/ASCT in previously untreated patients with aggressive lymphoma. A prospective randomized controlled trial is warranted to confirm these results.
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Combination chemotherapy with adriamycin, cyclophosphamide, vincristine, methotrexate, etoposide and dexamethasone (ACOMED) followed by involved field radiotherapy induces high remission rates and durable long-term survival in patients with aggressive malignant non-Hodgkin's lymphomas: long-term follow-up of a pilot study. Leuk Lymphoma. 2005 Dec;46(12):1729-34. PMID: 16353313
"After a median observation time of 10 years and 2 months, 16/22 (73%) patients are alive in continuous complete response without evidence of any late toxicities."
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Mitoxantrone, carboplatin, cytosine arabinoside, and methylprednisolone followed by autologous peripheral blood stem cell transplantation (MiCMA): a salvage regimen for patients with refractory or recurrent non-Hodgkin lymphoma. Cancer. 2006 Feb 15;106(4):859-66. PMID: 16419074
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Four versus six courses of a dose-escalated cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) regimen plus etoposide (megaCHOEP) and autologous stem cell transplantation: early dose intensity is crucial in treating younger patients with poor prognosis aggressive lymphoma.
Cancer. 2006 Jan 1;106(1):136-45. PMID: 16331635
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Concurrent administration of high-dose rituximab before and after autologous stem-cell transplantation for relapsed aggressive B-cell non-Hodgkin's lymphomas. J Clin Oncol. 2005 Apr 1;23(10):2240-7. PMID: 15800314
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Intensive Treatment More Effective Than CHOP for aggressive NHL CancerConsultants.com 3/04
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ACVBP regimen vs. CHOP in the treatment of advanced aggressive non-hodgkin's lymphoma (NHL). Results of the LNH93-5 study with a median follow-up of 5 years. Abstract No: 2307
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Treating Aggressive Non-Hodgkin's Lymphoma - Non-Hodgkin's Lymphoma: Where Do We Stand Today? - John D. Hainsworth, MD - Medscape 2003 (free login req.)
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Localized aggressive NHL - intent is cure: Chemotherapy alone compared with chemotherapy plus radiotherapy for localized intermediate- and high-grade non-Hodgkin's lymphoma. N Engl J Med. 1998 Jul 2;339(1):21-6. PMID: 9647875 PubMed | Related abstracts
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Treatment approaches, overview for indolent and aggressive MSKCC
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High-Dose Therapy for Follicular Lymphoma cancernetwork
Arnold Freedman, MD, Jonathan W. Friedberg, MD , and John Gribben, MD, PhD Department of Medicine, Harvard Medical School, Dana-Farber Cancer Institute, Boston, Massachusetts
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Lymphoma Diagnosis and Treatment: CHOP, MALT, PET, and More Medscape (free login, req.)
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Treatment overview - Best Practices of Medicine for NHL & HD Merck Medicus
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