Indolent Lymphoma - The Lymphoma That We Don't Treat

What is indolent lymphoma?

Indolent lymphoma is a group of low-grade lymphomas that are slowly progressive and most don't benefit from treatment with chemotherapy (unless the patient is feeling sick). These lymphomas comprise up to 1/3 of all canine lymphoma.

Since the disease course is vastly different from the more common and more aggressive diffuse large B cell lymphoma and peripheral T cell lymphoma, an accurate diagnosis is essential.

Examples of indolent lymphoma include T zone lymphoma, marginal zone lymphoma, and follicular lymphoma.

T zone lymphoma actually accounts for 12% of all lymphoma in dogs and is frequently misdiagnosed.

Forty percent of dogs that develop T zone lymphoma are golden retrievers - it is most common in this breed. The median age at diagnosis (half are older and half are younger) is 10 years; most dogs have enlarged lymph nodes and an elevated lymphocyte count on blood work, but feel normal.

What is the cause of indolent lymphoma?

A recent paper showed that T zone lymphoma occurred significantly less frequently in golden retrievers that had a history of hypothyroidism and omega-3 fatty acid supplementation, and more frequently in those that had a history of mange. More work is being done to fully understand this disease.

How do we diagnose indolent lymphoma?

To diagnose indolent lymphoma, typically flow cytometry is used (this involves sending a special aspirate to Colorado State often using a lymph node sample). Sometimes it involves a lymph node biopsy or a combination of tests. Normally, if we have a "larger than normal" lymph node, we start with a lymph node aspirate (for cytology), then plan on submitting a sample for flow cytometry if we suspect an indolent lymphoma.

How do we treat indolent lymphoma?

Studies have shown that this group of diseases does not appear to benefit from chemotherapy (unless they're feeling sick).

If the patient has a mass in the spleen or if the spleen is quite large, removing the spleen would likely be recommended.

What is the prognosis for indolent lymphoma?

Patients are typically expected to live for years with indolent lymphoma. Most dogs with indolent lymphoma will die from other causes (not from lymphoma).

For dogs with splenic marginal zone lymphoma, the prognosis is influenced by how the dog feels at diagnosis. If they feel sick at diagnosis and undergo splenectomy (removal of the spleen), they live an average of 309 days according to one study. If they feel normal at diagnosis and undergo splenectomy, they live an average of 1,153 days (3.2 years).

The average survival for dogs with T zone lymphoma (according to one study) is 33.5 months.

If you think your dog might have an indolent lymphoma and your primary care provider is not able to make a definitive diagnosis, get a second opinion from an oncologist or ask your vet if they'd be willing to call a local oncologist.

It's important to have an accurate diagnosis so you have a clear picture on your dog's prognosis as well as whether treatment is indicated or not.

Dr. Lori Cesario

Board Certified Veterinary Oncologist

PS: I'm happy to now offer online oncology consultations. Learn more about how this service can help by visiting the Vet Cancer Consultants site.

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(2) 6 Steps To Get The Most Out of Your Oncology Consult!

(3) Help! What Are They Talking About? (Part 2)

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