Indolent NHL types have a relatively good prognosis with a median survival as long as 20 years, but they usually are not curable in advanced clinical stages. Early-stage (stage I and stage II) indolent NHL can be effectively treated with radiation therapy alone.
Most of the indolent types are nodular (or follicular) in morphology.
On a comparative basis, it is difficult to prove benefit when relapsing disease is followed with watchful waiting, or when the median survival is more than 10 years.
Follicular lymphoma and primary follicular lymphoma of the duodenum are particularly indolent variants that rarely progress and rarely require therapy.[20,21] A so-called pediatric-type nodal follicular lymphoma has indolent behavior and rarely recurs; adult patients with this histologic variant are characterized by a lack of rearrangement in conjunction with a Ki-67 proliferation index greater than 30% and a localized stage I presentation. Patients with indolent lymphoma may experience a relapse with a more aggressive histology.
Asymptomatic patients can be monitored for evidence of disease progression without immediate need for chemotherapy.[9,30,31] Prognostic factors associated with symptoms requiring therapy include the following: The management of lymphoplasmacytic lymphoma is similar to that of other low-grade lymphomas, especially diffuse, small lymphocytic lymphoma/chronic lymphocytic leukemia.[30,32-34] If the viscosity relative to water is greater than four, the patient may have manifestations of hyperviscosity.