{"entity":{"id":"lymphoma-indolent-versus-aggressive","kind":"term","name":"Indolent and aggressive lymphoma","aka":["indolent lymphoma","aggressive lymphoma","low-grade lymphoma","high-grade lymphoma","slow-growing lymphoma","fast-growing lymphoma"],"tldr":"Lymphomas are split by how fast they grow, and the split decides what happens next. Aggressive lymphomas grow over weeks, are treated at once and are often cured. Indolent lymphomas grow over years, are often watched rather than treated, and are usually controlled for a long time rather than cured. The fast ones are the curable ones, which is the opposite of what most people expect.","summary":"Aggressive lymphomas double in weeks and cause symptoms quickly: diffuse large B-cell lymphoma, high-grade B-cell lymphoma, Burkitt lymphoma, most nodal T-cell lymphomas, blastoid mantle cell lymphoma. They are treated with combination chemotherapy within days or weeks of diagnosis, with the intention to cure, and a substantial proportion of people are cured. Burkitt lymphoma, the fastest-growing human tumour, is among the most curable.\n\nIndolent lymphomas grow over years and may cause no symptoms at all: follicular lymphoma, marginal zone lymphoma, lymphoplasmacytic lymphoma, most cutaneous T-cell lymphoma, chronic lymphocytic leukaemia. With current treatments they are generally not cured, but they are compatible with a long life, and many people need no treatment for years after diagnosis. Starting treatment earlier in a person with no symptoms has been tested and does not make them live longer, which is why watching and waiting is a treatment decision rather than a delay.\n\nThe practical consequences differ at every step. Urgency: an aggressive lymphoma is a matter of days, an indolent one rarely is. Intent: cure against control. Response: an aggressive lymphoma that does not respond is a serious problem quickly, while an indolent one that comes back is usually treated again. Scans: an aggressive lymphoma is usually followed by PET, an indolent one often by examination and blood tests alone.\n\nThe two categories are not permanent. An indolent lymphoma can transform into an aggressive one, which is the commonest way follicular lymphoma causes death and which WHO-HAEM5 recognised in 2022 by making transformation a family of its own. The reverse does not happen.","asOf":"2026-09-29","links":[{"label":"WHO Classification of Haematolymphoid Tumours, 5th edition: lymphoid neoplasms (Alaggio, Leukemia 2022)","url":"https://doi.org/10.1038/s41375-022-01620-2"},{"label":"NCI PDQ: adult non-Hodgkin lymphoma treatment (patient version)","url":"https://www.cancer.gov/types/lymphoma/patient/adult-nhl-treatment-pdq"},{"label":"Lymphoma Action: types of lymphoma (UK patient charity)","url":"https://lymphoma-action.org.uk/types-lymphoma"}],"tags":["heme","lymphoma"],"related":["lymphoma-transformation","lymphoma-tx-watch-and-wait","lymphoma-type"],"cancers":["non-hodgkin-lymphoma","follicular-lymphoma","dlbcl","marginal-zone-lymphoma"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"category":"Clinical"},"route":"/terms/lymphoma-indolent-versus-aggressive/","neighbours":{"term":[{"id":"lymphoma-type","kind":"term","name":"Lymphoma (tissue type)","route":"/terms/lymphoma-type/"},{"id":"lymphoma-classification-2022","kind":"term","name":"The two lymphoma classifications of 2022 (WHO-HAEM5 and ICC)","route":"/terms/lymphoma-classification-2022/"},{"id":"lymphoma-transformation","kind":"term","name":"Transformation of an indolent lymphoma","route":"/terms/lymphoma-transformation/"},{"id":"lymphoma-tx-watch-and-wait","kind":"term","name":"Watch and wait in lymphoma: when the right treatment is none yet","route":"/terms/lymphoma-tx-watch-and-wait/"}],"cancer":[{"id":"cutaneous-t-cell-lymphoma","kind":"cancer","name":"Cutaneous T-cell lymphoma (mycosis fungoides and Sezary syndrome)","route":"/cancers/cutaneous-t-cell-lymphoma/"},{"id":"dlbcl","kind":"cancer","name":"Diffuse large B-cell lymphoma","route":"/cancers/dlbcl/"},{"id":"follicular-lymphoma","kind":"cancer","name":"Follicular lymphoma","route":"/cancers/follicular-lymphoma/"},{"id":"gastric-malt-lymphoma","kind":"cancer","name":"Gastric MALT lymphoma","route":"/cancers/gastric-malt-lymphoma/"},{"id":"high-grade-b-cell-lymphoma-myc-bcl2","kind":"cancer","name":"High-grade B-cell lymphoma with MYC and BCL2 rearrangements (double-hit lymphoma)","route":"/cancers/high-grade-b-cell-lymphoma-myc-bcl2/"},{"id":"lymphomatoid-papulosis","kind":"cancer","name":"Lymphomatoid papulosis","route":"/cancers/lymphomatoid-papulosis/"},{"id":"marginal-zone-lymphoma","kind":"cancer","name":"Marginal zone lymphoma","route":"/cancers/marginal-zone-lymphoma/"},{"id":"mediastinal-grey-zone-lymphoma","kind":"cancer","name":"Mediastinal grey zone lymphoma","route":"/cancers/mediastinal-grey-zone-lymphoma/"},{"id":"mycosis-fungoides","kind":"cancer","name":"Mycosis fungoides","route":"/cancers/mycosis-fungoides/"},{"id":"non-hodgkin-lymphoma","kind":"cancer","name":"Non-Hodgkin lymphoma (all types)","route":"/cancers/non-hodgkin-lymphoma/"},{"id":"ocular-adnexal-malt-lymphoma","kind":"cancer","name":"Ocular adnexal MALT lymphoma","route":"/cancers/ocular-adnexal-malt-lymphoma/"},{"id":"peripheral-t-cell-lymphoma","kind":"cancer","name":"Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma)","route":"/cancers/peripheral-t-cell-lymphoma/"},{"id":"primary-cutaneous-anaplastic-large-cell-lymphoma","kind":"cancer","name":"Primary cutaneous anaplastic large cell lymphoma","route":"/cancers/primary-cutaneous-anaplastic-large-cell-lymphoma/"},{"id":"t-cell-histiocyte-rich-large-b-cell-lymphoma","kind":"cancer","name":"T-cell/histiocyte-rich large B-cell lymphoma","route":"/cancers/t-cell-histiocyte-rich-large-b-cell-lymphoma/"},{"id":"waldenstrom","kind":"cancer","name":"Waldenström macroglobulinaemia","route":"/cancers/waldenstrom/"}]}}