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Initial treatment of limited stage (I/II) follicular lymphoma

Arnold S Freedman, MD
Jonathan W Friedberg, MD
Andrea K Ng, MD, MPH
Section Editor
Andrew Lister, MD, FRCP, FRCPath, FRCR
Deputy Editor
Rebecca F Connor, MD


Follicular lymphoma (FL) is the second most common type of non-Hodgkin lymphoma (NHL). It is the most common of the clinically indolent NHLs defined as those lymphomas in which survival of the untreated patient is measured in years. (See "Classification of the hematopoietic neoplasms".)

Treatment of FL depends on the stage of disease at presentation (table 1). Patients with limited (stage I) disease are candidates for radiation therapy, which is curative in a percentage of patients.

In contrast, patients with advanced (stage III/IV) disease are not cured with conventional therapies. Treatment of this latter group is more akin to the long-term management of a chronic disease with a focus on symptom control. Most patients with advanced disease will receive a number of different treatment modalities (eg, immunotherapy, chemoimmunotherapy, radiation therapy) in various combinations, often separated by several years without active therapy.

The management of patients with stage II FL is more variable. We typically offer treatment similar to that used for advanced stage disease, while other clinicians offer treatment similar to that used for stage I disease. (See 'Stage II FL' below.)

Treatment also depends on the histologic grade of the tumor as determined by the number of centroblasts per high power field. The recommendations presented here pertain to patients with histologic grade 1, 2, or 3a FL; patients with grade 3b FL are treated with regimens used for other clinically aggressive lymphomas (eg, diffuse large B cell lymphoma). (See 'Grade 3 FL' below.)

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Literature review current through: Nov 2017. | This topic last updated: Oct 25, 2017.
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