Initial treatment of limited stage (I/II) follicular lymphoma
- Arnold S Freedman, MD
Arnold S Freedman, MD
- Section Editor — Lymphoproliferative Disorders
- Professor of Medicine
- Harvard Medical School
- Jonathan W Friedberg, MD
Jonathan W Friedberg, MD
- Professor of Medicine
- James P Wilmot Cancer Center, University of Rochester
- Andrea K Ng, MD, MPH
Andrea K Ng, MD, MPH
- Professor, Radiation Oncology, Harvard Medical School
- Brigham and Women's Hospital
- Dana-Farber Cancer Institute
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.)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- PRETREATMENT EVALUATION
- INITIAL MANAGEMENT
- Our approach
- Radiation therapy (RT)
- - Efficacy and toxicity
- - Radiation field
- - Radiation dose
- Systemic therapy
- SPECIAL SITUATIONS
- Grade 3 FL
- Stage II FL
- Intrafollicular neoplasia ("in-situ") FL
- Primary intestinal FL
- Primary cutaneous FL
- Pediatric-type FL
- EVALUATION OF RESPONSE TO THERAPY
- SURVEILLANCE FOR RELAPSE
- CLINICAL TRIALS
- HISTOLOGIC TRANSFORMATION
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS