Follicular Lymphoma: Therapeutics and Management

Follicular lymphoma (FL) is the second most common form of non-Hodgkin lymphoma and the most common indolent lymphoma. In the modern era, prognosis is often favorable with many patients achieving long-term disease control. Management depends on disease stage, symptoms, and overall disease burden. Patients with limited-stage disease can often be cured with involved-site radiation. Upfront therapy is indicated in patients with advanced stage disease, including anti-CD20 monoclonal antibody monotherapy, combination chemoimmunotherapy, or radioimmunotherapy. Maintenance therapy may be beneficial as well. Relapsed or refractory FL is treated with similar chemoimmunotherapy regimens or with a number of novel agents. Hematopoietic stem cell transplant is an option in appropriately selected patients with high-risk disease. The treatment strategies presented pertain to patients with histologic grade 1, 2, or 3a FL; patients with grade 3b FL are best treated according to guidelines for aggressive B-cell lymphomas.