The Natural History of Initially Untreated Low-Grade Non-Hodgkin's Lymphomas

• Published in: The New England journal of medicine Vol. 311; no. 23; pp. 1471 - 1475
• Main Authors: Horning, Sandra J, Rosenberg, Saul A
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 06.12.1984
• Subjects: Adult; Aged; Biological and medical sciences; Cancer therapies; Chemotherapy; Female; Follow-Up Studies; Health risk assessment; Hematologic and hematopoietic diseases; Humans; Immunoglobulins; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Lymph Nodes - pathology; Lymphoma; Lymphoma - mortality; Lymphoma - pathology; Lymphoma, Non-Hodgkin - mortality; Lymphoma, Non-Hodgkin - pathology; Male; Medical prognosis; Medical sciences; Medicine; Middle Aged; Neoplasm Regression, Spontaneous; Non-Hodgkin's lymphoma; Evolution; Treatment; Cell differentiation; Non Hodgkin lymphoma; Survival
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJM198412063112303

To learn more about the natural history of low-grade non-Hodgkin's lymphoma, we have studied 83 patients in whom the advanced disease was initially managed without therapy. Actuarial survival was 82 per cent at 5 years and 73 per cent at 10 years. The median time until therapy was required was three years. Spontaneous regressions occurred in 19 untreated patients (23 per cent), including 30 per cent of patients with nodular, poorly differentiated lymphocytic lymphoma. Histologic transformation to an Intermediate-Grade or high-grade lymphoma occurred both before and after primary therapy. The actuarial risk of transformation among the initially untreated patients was similar to that in a group of patients treated at this institution immediately after diagnosis. Neither the time to histologic transformation nor the incidence of transformation was influenced by when therapy was started. (N Engl J Med 1984; 311:1471–5.) AMONG the non-Hodgkin's lymphomas, the histologic subtypes known as diffuse, well-differentiated lymphocytic lymphoma; nodular, poorly differentiated lymphocytic lymphoma; and nodular, mixed lymphocytic–histiocytic lymphoma as defined in the Rappaport classification have been described as "favorable" in prognosis by several clinicopathological studies. 1 More recently, a working formulation of the non-Hodgkin's lymphomas for clinical use has been developed by an international group of expert pathologists. 2 On the basis of survival data from multiple institutions, three histologic subtypes were considered "low-grade" or favorable for prognosis: small lymphocytic; follicular, small cleaved-cell; and follicular, mixed small cleaved-cell and large-cell, which correspond to the Rappaport designations diffuse, . . .