About
Lymphoma > Types of Lymphoma > Aggressive
and Indolent Lymphomas
Last update: 02/15/2008
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Lymphomas,
a cancer of immune cells called lymphocytes, are classified 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.
When a lymphocyte becomes malignant it's maturation stage -- and
there are many more than depicted below -- 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), as well as genetic
expression that controls all of the above.
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| Indolent Lymphomas |
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TOPIC SEARCH - PubMed: Diagnosis
| Review
| Therapies
| Prognosis
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What's New |
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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. 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
In Section I, Dr. Randy Gascoyne describes the
histologic, cytogenetic and biologic features of FL
that underlie its clinical variability. Key aspects of
the pathologic diagnosis of FL that have particular relevance
to the clinician are highlighted. A proposed model for
follicular lymphomagenesis and diffuse large B cell lymphoma transformation
has emerged and continues to evolve as the molecular story
unfolds. A biologic basis for clinical outcome in FL also appears
to be forthcoming.
In Section II, Dr. Jane Winter addresses the
complex process of selecting among the many treatment
options for patients with FL. Previously a simple
matter of deciding between oral or intravenous alkylators,
clinicians and patients must now struggle to choose among
vastly different approaches ranging from "watch and
wait" to stem cell transplantation. The
introduction of rituximab and radioimmunoconjugates is
changing the treatment paradigm, but the optimal
approach to integrating these and other new agents
remains to be determined. At every decision point, the best
approach is always a clinical trial.
In Section III, Dr. Koen Van Besien provides a well-documented
update on outcomes associated with autologous and allogeneic
stem cell transplantation for FL. The results of trials of
autologous stem cell transplantation in first remission
and recent data supporting a role for graft purging are
discussed. Based on the premise that a
graft-versus-lymphoma effect is operative in FL,
reduced-intensity allogeneic transplantation is the preferred
approach in many cases, and recently reported results are
summarized. Criteria for patient selection and the
optimal role of transplantation in the overall
therapeutic plan for the patient with FL are presented.
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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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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 for last year - 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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Adult T-cell leukemia/lymphoma |
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Angioimmunoblastic |
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Anaplastic large cell
(T-cell/null cell) |
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Lymphoblastic
lymphoma/leukemia
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Precursor T-cell |
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Peripheral T-cell |
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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:
| 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
No different outcomes were observed between patients
achieving an early negative Ga (67)S response treated with
MegaCHOP and BEAM/ ASCT and patients with midtreatment positive Ga
(67)S who received IFE prior BEAM/ ASCT. Conclusions: This
response adapted strategy including early treatment modifications
prior HDT/ ASCT have yielded encouraging PFS and OS in patients
with poor risk aggressive NHL.
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| Antibody Therapy in Aggressive Lymphomas asheducationbook.hematologylibrary.org
Targeted therapies with monoclonal antibodies and monoclonal
antibodies conjugated to radioimmunoconjugates have altered
the natural history and the approach to treatment of
aggressive non-Hodgkin lymphomas.
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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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