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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.
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.
Indolent 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.
The 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.
The 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.
Leukaemias, myeloma and MDS live in the marrow and blood; lymphomas grow in lymph nodes and spleen. The node stations are the disease map, not a route of spread, and staging counts them.
In lymphoma the node stations are the disease itself; staging (Ann Arbor / Lugano) counts how many regions and sides of the diaphragm are involved.
Same organ: High-grade B-cell lymphoma with MYC and BCL2 rearrangements (double-hit lymphoma), Mediastinal grey zone lymphoma, Primary effusion lymphoma, Plasmablastic lymphoma, T-cell/histiocyte-rich large B-cell lymphoma, EBV-positive diffuse large B-cell lymphoma, Primary large B-cell lymphoma of the testis, Gastric MALT lymphoma, Ocular adnexal MALT lymphoma, Extranodal NK/T-cell lymphoma, Adult T-cell leukaemia/lymphoma, ALK-positive anaplastic large cell lymphoma, ALK-negative anaplastic large cell lymphoma, Breast implant-associated anaplastic large cell lymphoma, Primary cutaneous anaplastic large cell lymphoma, Lymphomatoid papulosis, Mycosis fungoides, Enteropathy-associated T-cell lymphoma, Monomorphic epitheliotropic intestinal T-cell lymphoma, Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma), Splenic marginal zone lymphoma, Nodal marginal zone lymphoma, Primary cutaneous marginal zone lymphoma, Primary cutaneous follicle centre lymphoma, Sezary syndrome, Nodal T-follicular helper cell lymphoma, angioimmunoblastic type (angioimmunoblastic T-cell lymphoma), Hepatosplenic T-cell lymphoma, Intravascular large B-cell lymphoma, Lymphomatoid granulomatosis, T-cell prolymphocytic leukaemia, Splenic B-cell lymphoma/leukaemia with prominent nucleoli (formerly B-cell prolymphocytic leukaemia and hairy cell leukaemia variant), T-cell large granular lymphocytic leukaemia, Mixed-phenotype acute leukaemia, Myeloid leukaemia of Down syndrome, Burkitt leukaemia, Marginal zone lymphoma, Cutaneous T-cell lymphoma (mycosis fungoides and Sezary syndrome), Primary mediastinal (thymic) large B-cell lymphoma, Leukaemia (all types), Acute myeloid leukaemia, Acute lymphoblastic leukaemia, Chronic lymphocytic leukaemia, Chronic myeloid leukaemia (CML), Diffuse large B-cell lymphoma, Follicular lymphoma, Hodgkin lymphoma, Mantle cell lymphoma, Multiple myeloma, Myelodysplastic syndromes / neoplasms (MDS), Myeloproliferative neoplasms (PV, ET, myelofibrosis), Polycythaemia vera (PV), Essential thrombocythaemia (ET), Waldenström macroglobulinaemia, Hairy cell leukaemia, Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma), Blastic plasmacytoid dendritic cell neoplasm (BPDCN), Burkitt lymphoma, HIV-associated (AIDS-related) lymphomas, Chronic myelomonocytic leukaemia and MDS/MPN overlap neoplasms, Systemic mastocytosis, Erdheim-Chester disease, Rosai-Dorfman disease and other histiocytic neoplasms, Langerhans cell histiocytosis (LCH), Post-transplant lymphoproliferative disorder (PTLD), FLT3-mutated acute myeloid leukaemia, IDH1- and IDH2-mutated acute myeloid leukaemia, NPM1-mutated and KMT2A-rearranged acute myeloid leukaemia, Secondary and therapy-related acute myeloid leukaemia, Acute promyelocytic leukaemia, Acute myeloid leukaemia in older or unfit patients, Smouldering multiple myeloma, Newly diagnosed multiple myeloma, transplant-eligible, Newly diagnosed multiple myeloma, transplant-ineligible, Relapsed or refractory multiple myeloma, Plasma cell leukaemia, Lower-risk myelodysplastic syndromes, Higher-risk myelodysplastic syndromes, Chronic lymphocytic leukaemia, first treatment, Relapsed or refractory chronic lymphocytic leukaemia, Richter transformation of chronic lymphocytic leukaemia, Chronic myeloid leukaemia, chronic phase, Chronic myeloid leukaemia, accelerated and blast phase, Primary myelofibrosis, Standard-risk B-cell acute lymphoblastic leukaemia in children, High-risk acute lymphoblastic leukaemia in children (high-risk B-ALL and T-ALL), Philadelphia chromosome-positive acute lymphoblastic leukaemia in children (Ph-positive ALL), Philadelphia chromosome-like acute lymphoblastic leukaemia (Ph-like or BCR::ABL1-like ALL), Infant acute lymphoblastic leukaemia (KMT2A-rearranged, under one year), Relapsed and refractory acute lymphoblastic leukaemia in children, Acute myeloid leukaemia in children, Erdheim-Chester disease, Rosai-Dorfman-Destombes disease, Single-system Langerhans cell histiocytosis (bone, skin or one other organ), Multisystem Langerhans cell histiocytosis (with or without risk-organ involvement), Indolent and smouldering systemic mastocytosis, Advanced systemic mastocytosis (aggressive SM, SM with an associated haematological neoplasm, mast cell leukaemia), Early-stage classical Hodgkin lymphoma (stage I to II), Advanced-stage classical Hodgkin lymphoma (stage III to IV), Nodular lymphocyte-predominant Hodgkin lymphoma (nodular lymphocyte-predominant B-cell lymphoma), Relapsed and refractory classical Hodgkin lymphoma
Showing the organ this term concerns: Non-Hodgkin lymphoma (all types).
Shares Lymphomatoid papulosis, Ocular adnexal MALT lymphoma, Primary cutaneous anaplastic large cell lymphoma, Gastric MALT lymphoma and the tags heme, lymphoma.
Shares T-cell/histiocyte-rich large B-cell lymphoma, Lymphoma (tissue type), The two lymphoma classifications of 2022 (WHO-HAEM5 and ICC), Cutaneous T-cell lymphoma (mycosis fungoides and Sezary syndrome) and the tags heme, lymphoma.
Shares Lymphoma (tissue type), Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma), Non-Hodgkin lymphoma (all types) and the tags heme, lymphoma.
Shares Gastric MALT lymphoma, Marginal zone lymphoma, Non-Hodgkin lymphoma (all types) and the tags heme, lymphoma.
Shares Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma), Non-Hodgkin lymphoma (all types) and the tags heme, lymphoma.
Shares Mediastinal grey zone lymphoma, The two lymphoma classifications of 2022 (WHO-HAEM5 and ICC), Diffuse large B-cell lymphoma, Non-Hodgkin lymphoma (all types) and the tags heme, lymphoma.
Shares Watch and wait in lymphoma: when the right treatment is none yet, The two lymphoma classifications of 2022 (WHO-HAEM5 and ICC), Cutaneous T-cell lymphoma (mycosis fungoides and Sezary syndrome), Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma) and the tags heme, lymphoma.
Shares Primary cutaneous anaplastic large cell lymphoma, The two lymphoma classifications of 2022 (WHO-HAEM5 and ICC), Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma), Non-Hodgkin lymphoma (all types) and the tags heme, lymphoma.