Indolent non-Hodgkin's lymphoma
Indolent non-Hodgkin's lymphoma is one of the two main classifications of non-Hodgkin's lymphoma, the other being aggressive. Indolent non-Hodgkin's lymphomas are sometimes known as 'slow-growing' or 'low-grade' non-Hodgkin's lymphomas.
Indolent non-Hodgkin's lymphomas are sometimes known as slow-growing or low-grade non-Hodgkin's lymphomas.
As these names suggest, indolent non-Hodgkin's lymphomas grow only very slowly. They typically cause no symptoms at first, and so they often remain undetected for some time. Indeed, they are often discovered 'by accident', such as when a patient is visiting the doctor for some other reason altogether. In these circumstances, the doctor may discover an enlarged lymph node during a routine physical examination, Sometimes, an investigation, such as a blood test or a chest X-ray, may reveal something abnormal, which is then investigated further and found to be due to non-Hodgkin's lymphoma.
However, some patients with indolent non-Hodgkin's lymphoma go to their doctor because of symptoms. The most common symptom is an enlarged lymph node, which is noticed as a lump, usually in the neck, armpit or groin. Patients at the time of diagnosis may also have any of the other symptoms of non-Hodgkin's lymphoma.
Because indolent non-Hodgkin's lymphomas grow slowly and often cause no symptoms, many of them are at quite an advanced stage when they are first diagnosed.
Treatments are available for all types of non-Hodgkin's lymphoma. A complete cure is not always possible but, in the case of indolent non-Hodgkin's lymphoma, it is usually possible to provide a remission or at least to shrink the lymphoma so that it does not cause symptoms. Sometimes a remission, or symptom-free period, will last for many years.
The type of treatment used will depend on many things, including:
Although a remission can usually be achieved with treatment, many indolent non-Hodgkin's lymphomas relapse at some time in the future, typically after between 1.5 and 4 years. Some indolent non-Hodgkin's lymphomas relapse in a different form, as an aggressive lymphoma. It is therefore very important that patients who have had treatment for an indolent non-Hodgkin's lymphoma should have regular check-ups and tests, as recommended by their doctor or specialist team, even if they are feeling perfectly well.
Patients with early-stage indolent non-Hodgkin's lymphoma that is confined to just one or two groups of lymph nodes at the time of diagnosis, which is quite rare, often have radiotherapy to those nodes. This treatment often achieves a cure.
Patients with advanced-stage indolent non-Hodgkin's lymphoma but no symptoms at the time of diagnosis often need no treatment to start with, and a 'watch and wait' approach is often recommended.
When symptoms develop, and for patients with symptoms at the time of diagnosis, treatment will generally be needed. The most common treatment is chemotherapy, often in combination with the monoclonal antibody rituximab. Radiotherapy is also sometimes used, together with the chemotherapy, to treat bulky masses of lymphoma. Other treatments that can be used include monoclonal antibody therapy alone or high-dose chemotherapy followed by a bone marrow transplant.
Although it is not possible to predict how a patient will respond to treatment, about 75% of patients with advanced-stage indolent non-Hodgkin's lymphoma have a remission. The average survival time is between seven and 10 years. Most patients with this form of the disease have a relapse, despite having had treatment. The length of time between treatment and relapse can vary, but it is usually between 1.5 and 4 years.
In patients whose non-Hodgkin's lymphoma does not respond to first-line treatment, and in patients whose lymphoma has relapsed, different treatments or treatment combinations may be tried.
The best treatment for relapsed disease depends on many things. Some older patients may be advised to have a 'watch and wait' approach if they have no symptoms that are troubling them. Most patients, however, are given combination chemotherapy, often with monoclonal antibody therapy.
If the indolent non-Hodgkin's lymphoma relapses in an aggressive form, treatment with high-dose chemotherapy with or without a stem cell transplant may be tried. If high-dose treatment is not possible, then medical management is likely to be palliative.
For more information on this topic, see How non-Hodgkin's lymphoma is treated.