The most common type of blood cancer is known as lymphoma. It develops due to the abnormal reproduction and enlargement of a type of white blood cell called lymphocytes. There are several types of lymphoma and different parts of the body where the disease can develop. The two main sub-types of lymphoma are Hodgkin’s and non-Hodgkin’s lymphoma, and the disease can have its origin in either B-cells or T-cells. The lymphomas are also classified according to growth velocity, being either indolent or aggressive.
Indolent lymphoma is a type of slow-growing cancer considered incurable most of the time, but due to its characteristics, patients often live for several years with the disease. Even though it’s not curable at this time, indolent lymphomas respond well to treatment in most patients. The first signs of the disease include swollen but painless lymph nodes, but the unique features of the lymphoma make it more difficult to diagnose, and it requires a different course of treatment than other lymphomas.
Indolent Lymphoma Development and Risk Factors
There are a series of indolent lymphomas, which can be localized during the first stages of the disease or spread to other locations in advanced cases.
Types of indolent lymphomas include follicular lymphoma; small lymphocytic lymphoma; nodal marginal zone B-cell lymphoma; lymphoplasmacytic lymphoma; anaplastic large cell lymphoma; primary cutaneous type; and mycosis fungoides. All are non-Hodgkin’s lymphomas, but some of them can turn from indolent to aggressive.
About 160,000 patients survived in the U.S. with lymphoma in 2011, according to the Leukemia and Lymphoma Society. Of that number, 502,943 people had non-Hodgkin’s lymphoma, and about 40 percent of those cases were diagnosed as indolent. Reasons why one lymphoma is indolent instead of aggressive are not totally understood. However, patients with the indolent type are usually older, and it affects both men and women nearly equally.
Indolent Lymphoma Symptoms and Diagnosis
The first symptoms of an indolent lymphoma are usually swollen but painless lymph nodes, at times followed by fever; night sweats; unexplained weight loss; fatigue; bone, abdominal or chest pain; loss of appetite; itching; and nausea. However, in most cases of indolent lymphoma, symptoms go unnoticed or are at least imperceptible for a long period of time.
Confirming the diagnosis can be difficult. To do so, physicians usually require a complete physical examination, a biopsy to analyze the tissue, as well as computed tomographic (CT) imaging to the chest, abdomen, and pelvis or other area, a chest x-ray, a positron emission tomography (PET) scan, spinal fluid exam, and blood tests to evaluate the stage and extent of the disease.
Treatment and Prognosis of Indolent Lymphoma
Patients who suffer from indolent lymphoma live an average of 10 to 15 years or longer after diagnosis due to its slow-growing characteristics. In fact, even when diagnosed early, in some cases physicians decide to watch and wait instead of a more aggressive treatment approach. In addition to the type of lymphoma, the treatment is also influenced by other factors, such as patient’s age, gender, or additional diseases.
When the physician believes the patients needs to be treated, one of the most common practices is to start with the administration of the monoclonal antibody rituximab alone or together with a single chemotherapy drug like bendamustine or fludarabine, or with a combination of drugs like CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone). A more drastic approach includes using the monoclonal antibodies ibritumomab and tositumomab as a second-line therapy.
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