Indolent lymphoma

Last updated
Indolent lymphoma
Other namesLow-grade lymphoma
Marrow Follicullar lymphoma.jpg
Follicular lymphoma in the bone marrow
Specialty Hematology and oncology
Symptoms Swollen lymph nodes, chest or abdominal pain, skin lump [1]
Usual onset60s
Treatment Watchful waiting, chemotherapy, radiation therapy, targeted therapy, immunotherapy [2]

Indolent lymphoma, also known as low-grade lymphoma, is a group of slow-growing non-Hodgkin lymphomas (NHLs). [3] Because they spread slowly, they tend to have fewer signs and symptoms when first diagnosed and may not require immediate treatment. Symptoms can include swollen but painless lymph nodes, unexplained fever, and unintended weight loss. [2]

Contents

There are several subtypes, the most common of which is follicular lymphoma. Others include cutaneous T-cell lymphoma, marginal zone lymphoma, chronic lymphocytic leukemia, and Waldenström macroglobulinemia. [2]

Indolent lymphoma accounts for 41 percent of all non-Hodgkin lymphoma cases in North America and Northern Europe. It mainly affects older adults, and affects men and women almost equally. [4] White people have higher incidence rates than black and Asian people, [5] but the cause of these disparities is poorly understood. [5]

Indolent lymphoma is usually considered incurable without the use of allogeneic stem cell transplantation, unless the disease is localised. However, due to its slow-growing nature and response to treatment, patients often have prolonged survival. [5]

Signs and symptoms

Patients normally present with painless, swollen lymph nodes, often in the neck, armpit, or groin. [1] Some have swollen lymph nodes inside their body, such as in the chest or abdomen, which can go undetected until they become very large and cause symptoms like cough or abdominal pain. [1]

Risk factors

The cause of indolent lymphoma is unknown, but research has identified a number of factors that increase risk.[ citation needed ]

Age

The risk of developing indolent lymphoma increases with age. Although the disease can occur at any age, it mainly affects older adults. It is uncommon in people under age 40 and very rare in children.[ citation needed ]

Infection

People with HIV are at slightly higher risk than the general population. [6] For patients who were previously diagnosed with an AIDS-defining illness, the risk of developing indolent lymphoma is 14-fold higher. [7]

Other factors

First-degree family history of non-Hodgkin lymphoma, hematological malignancy, or hepatitis C infection are linked to an increased risk of indolent lymphoma. [8] There are also specific risk factors for individual subtypes. Higher body mass index (BMI) as a young adult, occupation as a spray painter, sedentary lifestyle, and high levels of dietary animal protein intake are associated with higher risk of follicular lymphoma. [8] [9] Living on a farm is associated with an increased risk of mantle cell lymphoma. [8] Sjögren's syndrome, systemic lupus erythematosus, and tobacco smoking for more than 40 years are linked to an increased risk of Waldenstrom macroglobulinemia.[ citation needed ]

Diagnosis

Classification

With a few exceptions, indolent lymphomas are of B cell origin. [10] They are classified based on pathological and cytological features. [10] Subtypes include follicular lymphoma, marginal zone lymphoma, lymphoplasmacytic lymphoma, chronic lymphocytic leukemia, and hairy cell leukemia. [11]

Follicular lymphoma

Follicular lymphoma (FL) is a lymphoproliferative disorder generally associated with an indolent course. [12] It originates from follicular center B cells. [12] About 85% of cases show t(14;18)(q32;q21) chromosomal translocation, which causes the overexpression of the anti-apoptotic protein Bcl-2. [13]

FL is characterized by diffuse lymphadenopathy, bone marrow involvement, and splenomegaly. [12] Involvement of non-lymphatic areas is less common. [12] Cytopenias are relatively common, but constitutional symptoms such as fever, night sweats, and weight loss are rare in the absence of transformation to diffuse large B cell lymphoma. [12] The five-year survival rate in the United States is 88.4%. [14]

FL is the most prevalent form of indolent lymphoma, accounting for 70% of indolent cases and 20–30% of all non-Hodgkin lymphoma cases, with a yearly incidence of 1.6 to 3.1 per 100,000. [13] [15] It is most frequently diagnosed among people in their 50s and 60s, and is more common among white populations than black or Asian populations. [14]

Cutaneous T-cell lymphoma

Cutaneous T-cell lymphoma (very high magnification) Cutaneous T-cell lymphoma - very high mag.jpg
Cutaneous T-cell lymphoma (very high magnification)

Unlike most NHL subtypes, cutaneous T-cell lymphoma (CTCL) is derived from T cells. Mycosis fungoides, which attacks the skin, is the most common form of CTCL. [16] When cancer cells infiltrate and accumulate in the blood, it is known as Sézary syndrome. [16]

Diagnosis of CTCL is often delayed due to the presence of multiple clinical presentations and the lack of definitive diagnostic criteria. Patients can be misdiagnosed with a variety of benign skin conditions, including dermatitis, eczema, parapsoriasis, psoriasis, and adverse drug reactions. [16] It takes six years on average from disease onset to confirmation of diagnosis. [16]

Marginal zone lymphoma

Marginal zone lymphoma (MZL) is a heterogeneous group of indolent B cell lymphomas that arise from the marginal zone of lymphoid tissues. [17] It accounts for 5–10% of all NHL cases, with an annual incidence of 0.4 to 1.0 per 100,000 in Western countries. [18] The median age at diagnosis is 67 years, and the disease is slightly more common in women than in men. [19]

The World Health Organization categorizes MZL into three subtypes: nodal, extranodal, and splenic. [18] Nodal MZL occurs within the lymph nodes. Extranodal MZL occurs in areas outside the lymph nodes, with the stomach being the most common site. [19] Splenic MZL develops in the spleen and may spread to the blood. [17] [20]

Chronic lymphocytic leukemia and small cell lymphocytic lymphoma

Chronic lymphocytic leukemia (CLL) and small cell lymphocytic lymphoma (SLL) are different manifestations of the same disease and are managed in the same way. [21] When the abnormal lymphocytes are located mostly in the lymph nodes, it is referred to as SLL; when the abnormal lymphocytes are mostly in the blood and bone marrow, it is called CLL. [22]

CLL is the most common leukemia in Western countries, but it is very rare in East Asia. [23] The median age at diagnosis is 72 years. [21]

Staging

Staging describes the extent of indolent lymphoma, whether it has spread and, if so, how far it has spread. [2] The disease can spread through tissue, the lymphatic system and the blood. [2] The Lugano modification of the Ann Arbor system is used to stage lymphoma. [24]

Stage I: The lymphoma is in one lymph node or one group of lymph nodes; or, in rare cases, in one organ of the lymphatic system such as Waldeyer’s ring, the thymus, or the spleen; or in one site outside the lymphatic system (IE). [2]

Stage II: The lymphoma is in two or more groups of lymph nodes; or in one nearby area outside the lymphatic system, with or without involvement of other lymph nodes (IIE). In either case, the lymphoma sites are on the same side of the diaphragm. [2] In Stage II, "bulky disease" means tumor mass larger than a certain size; the threshold depends on the type of lymphoma. [2]

Stage III: The lymphoma is on both sides of the diaphragm, [2] either in lymph nodes both above and below the diaphragm, or in lymph nodes above the diaphragm and in the spleen. [2]

Stage IV: The lymphoma is in one or more organs beyond the lymphatic system, such as the liver, lungs, bone marrow, or cerebrospinal fluid. [2]

A patient's stage may be determined through blood tests, bone marrow biopsy, chest X-rays, computed tomography (CT) scans, positron emission tomography (PET) scans, and magnetic resonance imaging (MRI).[ citation needed ]

Treatment

Indolent lymphoma tends to grow slowly. As a result, patients may not need to start treatment immediately upon diagnosis. [25] Instead, they may be closely monitored—an approach known as watchful waiting—and start treatment when the disease progresses and causes symptoms, [25] or when they reach a certain number of cancer cells in their body even if there are no symptoms. [3] Treatment is highly individualized and depends on a range of factors, including the subtype of the disease, its stage, the patient's age, and other medical conditions. [17]

Patients with early-stage indolent lymphoma may be cured with radiation therapy, but most patients have widespread disease at the time of diagnosis. There are many effective treatments to control later stages, but they are not reliably curative. Allogeneic stem cell transplantation can be curative because of the potential for immunologic graft-versus-lymphoma effect, but there are significant concerns regarding non-relapse mortality. [26]

Treatment by stage

Stage I and contiguous Stage II

External radiation therapy (or external beam radiation therapy) may be given to affected lymph nodes and nearby lymph nodes. Other treatments include chemotherapy and monoclonal antibody therapy with rituximab. [2]

Noncontiguous Stage II, Stage III, and Stage IV

Treatments include rituximab, either alone or combined with chemotherapy; obinutuzumab; combination immunotherapy with lenalidomide and rituximab; and radiolabeled monoclonal antibody therapy. Phosphatidylinositol 3-kinase (PI3K) inhibitors such as copanlisib, idelalisib, or duvelisib may be used to treat relapsed indolent lymphoma. [27] Clinical trials are also an option. [2]

Treatment by subtype

Follicular lymphoma

Some patients do not need treatment for several years, while others whose cancer has spread widely need it immediately. [17] In some cases, the disease can transform into an aggressive type of lymphoma such as diffuse large B-cell lymphoma (DLBCL). [17]

Patients who have Stage I or II follicular lymphoma may be treated with radiation therapy alone or with chemotherapy. [17] For patients who are in Stage II but have bulky disease, are in Stage III or IV, or have relapsed or refractory disease, treatment depends on the patient's age, overall health, disease progression, symptoms, and personal preferences. [17] Treatment options include watchful waiting, radiation aimed directly at the affected lymph nodes, chemotherapy, and immunotherapy. For patients whose disease becomes more aggressive, autologous stem cell transplantation may be used.[ citation needed ]

There is no consensus on the optimal first-line treatment for follicular lymphoma. Some studies have found no difference in life expectancy or quality of life between asymptomatic patients who receive treatment and those who are closely monitored without treatment. Other doctors believe that potentially curative radiation therapy is underused, and that this may lead to excessive treatments and costs in the long term. [28]

Marginal zone lymphoma

Gastric MZL is often related to Helicobacter pylori infection. Many patients can be cured with antibiotics alone. [17] If remission is not achieved, radiation therapy may be used. For nodal MZL that involves the spleen and blood, treatment is similar to that of follicular lymphoma. [17]

Prognosis

Although indolent lymphoma tends to progress slowly and median overall survival is more than 10 years, prognoses differs substantially both within and between subtypes. [5] [29] Some patients live many years longer than the median survival, while others die a short time after diagnosis. [30]

Patients with HIV infection tend to have similar median survival as patients who are HIV negative. [7] Younger patients have higher five-year survival rates than older patients. [31] A study in the Netherlands shows that in the younger age group, mortality caused by follicular lymphoma and marginal zone lymphoma after 15 years is minimal, suggesting the likelihood of a cure. [31]

Related Research Articles

<span class="mw-page-title-main">Non-Hodgkin lymphoma</span> Type of cancer of lymph nodes

Non-Hodgkin lymphoma (NHL), also known as non-Hodgkin's lymphoma, is a group of blood cancers that includes all types of lymphomas except Hodgkin lymphomas. Symptoms include enlarged lymph nodes, fever, night sweats, weight loss, and tiredness. Other symptoms may include bone pain, chest pain, or itchiness. Some forms are slow-growing while others are fast-growing.

<span class="mw-page-title-main">Lymphoma</span> Hematologic cancer that affects lymphocytes

Lymphoma is a group of blood and lymph tumors that develop from lymphocytes. The name typically refers to just the cancerous versions rather than all such tumours. Signs and symptoms may include enlarged lymph nodes, fever, drenching sweats, unintended weight loss, itching, and constantly feeling tired. The enlarged lymph nodes are usually painless. The sweats are most common at night.

<span class="mw-page-title-main">Chronic lymphocytic leukemia</span> Medical condition

Chronic lymphocytic leukemia (CLL) is a type of cancer in which the bone marrow makes too many lymphocytes. Early on, there are typically no symptoms. Later, non-painful lymph node swelling, feeling tired, fever, night sweats, or weight loss for no clear reason may occur. Enlargement of the spleen and low red blood cells (anemia) may also occur. It typically worsens gradually over years.

<span class="mw-page-title-main">Tumors of the hematopoietic and lymphoid tissues</span> Tumors that affect the blood, bone marrow, lymph, and lymphatic system

Tumors of the hematopoietic and lymphoid tissues or tumours of the haematopoietic and lymphoid tissues are tumors that affect the blood, bone marrow, lymph, and lymphatic system. Because these tissues are all intimately connected through both the circulatory system and the immune system, a disease affecting one will often affect the others as well, making aplasia, myeloproliferation and lymphoproliferation closely related and often overlapping problems. While uncommon in solid tumors, chromosomal translocations are a common cause of these diseases. This commonly leads to a different approach in diagnosis and treatment of hematological malignancies. Hematological malignancies are malignant neoplasms ("cancer"), and they are generally treated by specialists in hematology and/or oncology. In some centers "hematology/oncology" is a single subspecialty of internal medicine while in others they are considered separate divisions. Not all hematological disorders are malignant ("cancerous"); these other blood conditions may also be managed by a hematologist.

AIDS-related lymphoma describes lymphomas occurring in patients with acquired immunodeficiency syndrome (AIDS).

<span class="mw-page-title-main">Lymphadenopathy</span> Disease of lymph nodes

Lymphadenopathy or adenopathy is a disease of the lymph nodes, in which they are abnormal in size or consistency. Lymphadenopathy of an inflammatory type is lymphadenitis, producing swollen or enlarged lymph nodes. In clinical practice, the distinction between lymphadenopathy and lymphadenitis is rarely made and the words are usually treated as synonymous. Inflammation of the lymphatic vessels is known as lymphangitis. Infectious lymphadenitis affecting lymph nodes in the neck is often called scrofula.

<span class="mw-page-title-main">Follicular lymphoma</span> Medical condition

Follicular lymphoma (FL) is a cancer that involves certain types of white blood cells known as lymphocytes. The cancer originates from the uncontrolled division of specific types of B-cells known as centrocytes and centroblasts. These cells normally occupy the follicles in the germinal centers of lymphoid tissues such as lymph nodes. The cancerous cells in FL typically form follicular or follicle-like structures in the tissues they invade. These structures are usually the dominant histological feature of this cancer.

<span class="mw-page-title-main">Sézary disease</span> Medical condition

Sézary disease, or Sézary syndrome, is a type of cutaneous T-cell lymphoma that was first described by Albert Sézary. The affected T cells, known as Sézary's cells or Lutzner cells, have pathological quantities of mucopolysaccharides. Sézary disease is sometimes considered a late stage of mycosis fungoides with lymphadenopathy.

<span class="mw-page-title-main">T-cell lymphoma</span> Medical condition

T-cell lymphoma is a rare form of cancerous lymphoma affecting T-cells. Lymphoma arises mainly from the uncontrolled proliferation of T-cells and can become cancerous.

<span class="mw-page-title-main">Mediastinal tumors</span> Medical condition

A mediastinal tumor is a tumor in the mediastinum, the cavity that separates the lungs from the rest of the chest. It contains the heart, esophagus, trachea, thymus, and aorta. The most common mediastinal masses are neurogenic tumors, usually found in the posterior mediastinum, followed by thymoma (15–20%) located in the anterior mediastinum. Lung cancer typically spreads to the lymph nodes in the mediastinum.

<span class="mw-page-title-main">B-cell lymphoma</span> Blood cancer that affects B-type white blood cells

The B-cell lymphomas are types of lymphoma affecting B cells. Lymphomas are "blood cancers" in the lymph nodes. They develop more frequently in older adults and in immunocompromised individuals.

Richter's transformation (RT), also known as Richter's syndrome, is the conversion of chronic lymphocytic leukemia (CLL) or its variant, small lymphocytic lymphoma (SLL), into a new and more aggressively malignant disease. CLL is the circulation of malignant B lymphocytes with or without the infiltration of these cells into lymphatic or other tissues while SLL is the infiltration of these malignant B lymphocytes into lymphatic and/or other tissues with little or no circulation of these cells in the blood. CLL along with its SLL variant are grouped together in the term CLL/SLL.

<span class="mw-page-title-main">Mantle cell lymphoma</span> Type of blood cancer

Mantle cell lymphoma (MCL) is a type of non-Hodgkin's lymphoma, comprising about 6% of cases. It is named for the mantle zone of the lymph nodes where it develops. The term 'mantle cell lymphoma' was first adopted by Raffeld and Jaffe in 1991.

<span class="mw-page-title-main">Marginal zone lymphoma</span> Group of lymphomas

Marginal zone lymphomas, also known as marginal zone B-cell lymphomas (MZLs), are a heterogeneous group of lymphomas that derive from the malignant transformation of marginal zone B-cells. Marginal zone B cells are innate lymphoid cells that normally function by rapidly mounting IgM antibody immune responses to antigens such as those presented by infectious agents and damaged tissues. They are lymphocytes of the B-cell line that originate and mature in secondary lymphoid follicles and then move to the marginal zones of mucosa-associated lymphoid tissue (MALT), the spleen, or lymph nodes. Mucosa-associated lymphoid tissue is a diffuse system of small concentrations of lymphoid tissue found in various submucosal membrane sites of the body such as the gastrointestinal tract, mouth, nasal cavity, pharynx, thyroid gland, breast, lung, salivary glands, eye, skin and the human spleen.

<span class="mw-page-title-main">Nodular lymphocyte predominant Hodgkin lymphoma</span> Medical condition

Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) is a slow-growing CD20 positive form of Hodgkin lymphoma, a cancer of the immune system's B cells.

<span class="mw-page-title-main">Hodgkin lymphoma</span> Type of blood and immune-system cancer

Hodgkin lymphoma (HL) is a type of lymphoma in which cancer originates from a specific type of white blood cell called lymphocytes, where multinucleated Reed–Sternberg cells are present in the patient's lymph nodes. The condition was named after the English physician Thomas Hodgkin, who first described it in 1832. Symptoms may include fever, night sweats, and weight loss. Often, nonpainful enlarged lymph nodes occur in the neck, under the arm, or in the groin. Persons affected may feel tired or be itchy.

<span class="mw-page-title-main">Follicular hyperplasia</span> Medical condition of lymphatic cells

Follicular hyperplasia (FH) is a type of lymphoid hyperplasia and is classified as a lymphadenopathy, which means a disease of the lymph nodes. It is caused by a stimulation of the B cell compartment and by abnormal cell growth of secondary follicles. This typically occurs in the cortex without disrupting the lymph node capsule. The follicles are pathologically polymorphous, are often contrasting and varying in size and shape. Follicular hyperplasia is distinguished from follicular lymphoma in its polyclonality and lack of bcl-2 protein expression, whereas follicular lymphoma is monoclonal, and expresses bcl-2.

<span class="mw-page-title-main">Unicentric Castleman disease</span> Medical condition

Unicentric Castleman disease is a subtype of Castleman disease, a group of lymphoproliferative disorders characterized by lymph node enlargement, characteristic features on microscopic analysis of enlarged lymph node tissue, and a range of symptoms and clinical findings.

<span class="mw-page-title-main">Idiopathic multicentric Castleman disease</span> Medical condition

Idiopathic multicentric Castleman disease (iMCD) is a subtype of Castleman disease (also known as giant lymph node hyperplasia, lymphoid hamartoma, or angiofollicular lymph node hyperplasia), a group of lymphoproliferative disorders characterized by lymph node enlargement, characteristic features on microscopic analysis of enlarged lymph node tissue, and a range of symptoms and clinical findings.

Mature T-cell lymphoma, also called peripheral T-cell lymphoma, is a group of rare, aggressive lymphomas that develop from mature white blood cells and originate from lymphoid tissues outside of the bone marrow. Mature T-cell lymphoma is under the category of non-Hodgkin lymphoma. Mature T-cell lymphomas account for 10% to 15% of all lymphomas and is more common in Asia than in Europe and America. Its common subtypes include angioimmunoblastic T-cell lymphoma, anaplastic large cell lymphoma and peripheral T-cell lymphoma not otherwise specified. While different subtypes have variable symptoms, common symptoms include enlarged painless lymph nodes, fever, weight loss, rash and night sweats.

References

  1. 1 2 3 "Low-grade NHL symptoms and diagnosis". Bloodwise. 2015-07-01. Retrieved 2020-02-12.
  2. 1 2 3 4 5 6 7 8 9 10 11 12 13 "Adult Non-Hodgkin Lymphoma Treatment (PDQ®)–Patient Version". National Cancer Institute. 2019-11-29. Retrieved 2020-02-03.
  3. 1 2 "NCI Dictionary of Cancer Terms". National Cancer Institute. 2011-02-02. Retrieved 2020-02-03.
  4. ↑ PhD, Ines Martins (2016-02-02). "Indolent Lymphoma: What You Need to Know". Lymphoma News Today. Retrieved 2020-02-08.
  5. 1 2 3 4 Lunning, Matthew; Vose, Julie M. (2012). "Management of Indolent Lymphoma: Where Are We Now and Where Are We Going". Blood Reviews. 26 (6): 279–288. doi:10.1016/j.blre.2012.09.004. ISSN   0268-960X. PMC   3632507 . PMID   23063143.
  6. ↑ Grogg, K L; Miller, R F; Dogan, A (2007). "HIV infection and lymphoma". Journal of Clinical Pathology. 60 (12): 1365–1372. doi:10.1136/jcp.2007.051953. ISSN   0021-9746. PMC   2095580 . PMID   18042692.
  7. 1 2 Levine, Alexandra M.; Sadeghi, Saeed; Espina, Byron; Tulpule, Anil; Nathwani, Bharat (2002). "Characteristics of indolent non-hodgkin lymphoma in patients with type 1 human immunodeficiency virus infection". Cancer. 94 (5): 1500–1506. doi: 10.1002/cncr.10368 . ISSN   1097-0142. PMID   11920507.
  8. 1 2 3 Chihara, Dai; Nastoupil, Loretta J.; Williams, Jessica N.; Lee, Paul; Koff, Jean L.; Flowers, Christopher R. (2015). "New insights into the epidemiology of non-Hodgkin lymphoma and implications for therapy". Expert Review of Anticancer Therapy. 15 (5): 531–544. doi:10.1586/14737140.2015.1023712. ISSN   1473-7140. PMC   4698971 . PMID   25864967.
  9. ↑ Ambinder, Alexander J.; Shenoy, Pareen J.; Malik, Neha; Maggioncalda, Alison; Nastoupil, Loretta J.; Flowers, Christopher R. (2012). "Exploring Risk Factors for Follicular Lymphoma". Advances in Hematology. 2012: 626035. doi: 10.1155/2012/626035 . PMC   3458409 . PMID   23028387.
  10. 1 2 Ali W. Bseiso, M. D. (2005-04-02). "The Indolent Lymphomas". Cancer Network. Retrieved 2020-02-09.
  11. ↑ Zenhäusern, Reinhard (2013-03-27). "[Indolent lymphomas: classification, clinical presentation and treatment]]". Praxis. 102 (7): 399–406. doi:10.1024/1661-8157/a001239. ISSN   1661-8157. PMID   23531907.
  12. 1 2 3 4 5 Freedman, Arnold; Jacobsen, Eric (2020). "Follicular lymphoma: 2020 update on diagnosis and management". American Journal of Hematology. 95 (3): 316–327. doi: 10.1002/ajh.25696 . ISSN   1096-8652. PMID   31814159.
  13. 1 2 Castellino, Alessia; Vitolo, Umberto (2017-01-01). "Follicular Lymphoma: The Management of Elderly Patient". Mediterranean Journal of Hematology and Infectious Diseases. 9 (1): e2017009. doi:10.4084/mjhid.2017.009. ISSN   2035-3006. PMC   5224805 . PMID   28105297.
  14. 1 2 "Follicular Lymphoma - Cancer Stat Facts". SEER. Retrieved 2020-02-12.
  15. ↑ Pavanello, Francesca; Steffanoni, Sara; Ghielmini, Michele; Zucca, Emanuele (2016-11-07). "Systemic Front Line Therapy of Follicular Lymphoma: When, to Whom and How". Mediterranean Journal of Hematology and Infectious Diseases. 8 (1): e2016062. doi:10.4084/MJHID.2016.062. ISSN   2035-3006. PMC   5111519 . PMID   27872742.
  16. 1 2 3 4 Bagherani, Nooshin; Smoller, Bruce R. (2016-07-28). "An overview of cutaneous T cell lymphomas". F1000Research. 5: 1882. doi: 10.12688/f1000research.8829.1 . ISSN   2046-1402. PMC   4965697 . PMID   27540476.
  17. 1 2 3 4 5 6 7 8 9 gknation (2015-02-26). "Treatment for Indolent NHL Subtypes". www.lls.org. Retrieved 2020-02-08.
  18. 1 2 Chihara, Dai; Nastoupil, Loretta J.; Williams, Jessica N.; Lee, Paul; Koff, Jean L.; Flowers, Christopher R. (2015). "New insights into the epidemiology of non-Hodgkin lymphoma and implications for therapy". Expert Review of Anticancer Therapy. 15 (5): 531–544. doi:10.1586/14737140.2015.1023712. ISSN   1473-7140. PMC   4698971 . PMID   25864967.
  19. 1 2 Denlinger, Nathan M; Epperla, Narendranath; William, Basem M (2018-03-27). "Management of relapsed/refractory marginal zone lymphoma: focus on ibrutinib". Cancer Management and Research. 10: 615–624. doi: 10.2147/CMAR.S133291 . ISSN   1179-1322. PMC   5877869 . PMID   29628774.
  20. ↑ "Marginal Zone Lymphoma". Lymphoma Research Foundation. Retrieved 2020-02-11.
  21. 1 2 Zelenetz, Andrew D.; Gordon, Leo I.; Wierda, William G.; Abramson, Jeremy S.; Advani, Ranjana H.; Andreadis, C. Babis; Bartlett, Nancy; Byrd, John C.; Czuczman, Myron S.; Fayad, Luis E.; Fisher, Richard I. (2015). "Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma, Version 1.2015". Journal of the National Comprehensive Cancer Network. 13 (3): 326–362. doi:10.6004/jnccn.2015.0045. ISSN   1540-1405. PMC   4841457 . PMID   25736010.
  22. ↑ "NCI Dictionary of Cancer Terms". National Cancer Institute. 2011-02-02. Retrieved 2020-02-12.
  23. ↑ Takizawa, Jun; Gruber, Michaela; Suzuki, Ritsuro; Nakamura, Naoya; Hoermann, Gregor; Muellauer, Leonhard; Aoki, Sadao; Suzumiya, Junji; Jaeger, Ulrich (2016-12-02). "Comparative Analysis of Japanese and European Typical CLL Patients". Blood. 128 (22): 5564. doi: 10.1182/blood.V128.22.5564.5564 . ISSN   0006-4971.
  24. ↑ "Non-Hodgkin Lymphoma Guidelines: Classification, Diagnosis, Staging". 2019-11-11.{{cite journal}}: Cite journal requires |journal= (help)
  25. 1 2 "Lymphoma - Non-Hodgkin - Subtypes". Cancer.Net. 2012-06-25. Retrieved 2020-02-08.
  26. ↑ Kuruvilla, John (2016-04-28). "The role of autologous and allogeneic stem cell transplantation in the management of indolent B-cell lymphoma". Blood. 127 (17): 2093–2100. doi: 10.1182/blood-2015-11-624320 . ISSN   0006-4971. PMID   26989206.
  27. ↑ Mensah, Felix A; Blaize, Jean-Pierre; Bryan, Locke J (2018-08-13). "Spotlight on copanlisib and its potential in the treatment of relapsed/refractory follicular lymphoma: evidence to date". OncoTargets and Therapy. 11: 4817–4827. doi: 10.2147/OTT.S142264 . ISSN   1178-6930. PMC   6097514 . PMID   30147333.
  28. ↑ "Many Patients With Early-Stage Follicular Lymphoma May Not Receive Guideline-Recommended Radiation Therapy - The ASCO Post". ascopost.com. Retrieved 2020-02-25.
  29. ↑ Arcaini, Luca; Rattotti, Sara; Gotti, Manuel; Luminari, Stefano (2012-07-31). "Prognostic Assessment in Patients with Indolent B-Cell Lymphomas". The Scientific World Journal. 2012: 107892. doi: 10.1100/2012/107892 . ISSN   2356-6140. PMC   3417199 . PMID   22919288.
  30. ↑ CIOBANU, Anca; STANCA, Oana; TRIANTAFYLLIDIS, Irina; LUPU, Anca (2013). "Indolent Lymphoma: Diagnosis and Prognosis in Medical Practice". Mædica. 8 (4): 338–342. ISSN   1841-9038. PMC   3968468 . PMID   24790664.
  31. 1 2 Schans, Saskia A. M. van de; Steenbergen, Liza N. van; Coebergh, Jan Willem W.; Janssen-Heijnen, Maryska L. G.; Spronsen, Dick Johan van (2014-02-01). "Actual prognosis during follow-up of survivors of B-cell non-Hodgkin lymphoma in the Netherlands". Haematologica. 99 (2): 339–345. doi:10.3324/haematol.2012.081885. ISSN   0390-6078. PMC   3912965 . PMID   24038025.
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