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Follicular Lymphoma

Overview
Treatment Options
Treatments Under Investigation
Clinical Trials
Follow Up
Support
Resources

Overview

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Focus On FL

Lymphoma is the most common blood cancer. The two main forms of lymphoma are Hodgkin lymphoma and non-Hodgkin lymphoma (NHL). Lymphoma occurs when cells of the immune system called lymphocytes, a type of white blood cell, grow and multiply uncontrollably. These cancerous lymphocytes can travel to many parts of the body, including the lymph nodes, spleen, bone marrow, blood, or other organs, and form a mass called a tumor. The body has two main types of lymphocytes that can develop into lymphomas: B-lymphocytes (B-cells) and T-lymphocytes (T-cells).

Follicular lymphoma (FL), a B-cell lymphoma, is the most common indolent (slow-growing) form of NHL, accounting for approximately 20 percent to 30 percent of all NHLs. Common signs of disease include enlargement of the lymph nodes in the neck, underarm, stomach, or groin, as well as fatigue, shortness of breath, night sweats, and weight loss. Often, people with FL have no obvious symptoms of the disease at diagnosis.

Approximately 30 percent to 40 percent of patients with FL will eventually develop a transformed lymphoma, which is often more aggressive and usually treated with high-dose chemotherapy along with an autologous stem cell transplant.

Treatment Options

There are various treatment options for FL based on the severity of associated symptoms as well as the rate of cancer growth. If patients show no or very few symptoms, doctors may decide not to treat it right away, an approach referred to as "watch and wait" or "watchful waiting." Studies have shown that suitable patients who follow a "watch and wait" approach have outcomes similar to those being treated early in the course of their disease.

FL is generally very responsive to radiation and chemotherapy. Radiation can provide a cure in some patients with limited disease; in more advanced stages, physicians may use one or more chemotherapy drugs or the monoclonal antibody rituximab (Rituxan), alone or in combination. Common combination regimens include:

  • R-CVP (rituximab, cyclophosphamide, vincristine, prednisone)
  • R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone)
  • R-Bendamustine

Rituximab is also recommended as maintenance therapy. After treatment, many patients will have a remission that lasts for years; however, the disease does return in most patients. For these patients, additional therapies are often successful in providing another remission.

Radioimmunotherapy (RIT) may be used alone or in combination with chemotherapy to treat relapsed or refractory FL. Currently, two radioimmunotherapy drugs are commercially available: Iodine 131 tositumomab (Bexxar) and Y90 ibritumomab tiuxetan (Zevalin). While there are some differences between these two drugs, both produce similar clinical results with durable remissions for appropriate patients. To learn more about RIT, view the Lymphoma Research Foundation's (LRF's) Fact Sheet on Radioimmunotherapy.

For some patients with relapsed FL, high-dose chemotherapy and an autologous stem cell transplant (in which patients receive their own stem cells) or an allogeneic stem cell transplant (in which patients receive stem cells from a donor) may provide a prolonged disease-free interval.

Treatments Under Investigation

Many treatments are currently being tested in clinical trials for patients who are newly diagnosed or have relapsed/refractory FL. For example, rituxumab plus lenalidamide (Revlimid) is being assessed in treatment-naive patients, and Y90 ibritumomab tiuxetan is being investigated as consolidation therapy after R-CHOP in high-risk patients. Combinations of treatment modalities, immunochemotherapy, ibritumomab tiuxetan, and bone marrow transplant, are being investigated for helping patients have prolonged disease-free survival/remission. Other treatments under investigation include:

  • Bortezomib (Velcade)
  • Everolimus (Afinitor)
  • Idelalisib (GS-1101, formerly CAL-101)
  • Ibrutinib (PCI-32765)
  • Lenalidomide (Revlimid)
  • Ofatumumab (Arzerra)
  • Panobinostat

It is critical to remember that today's scientific research is continuously evolving. Treatment options may change as new treatments are discovered and current treatments are improved. Therefore, it is important that patients check with LRF or with their physician for any treatment updates that may have recently emerged.

Clinical Trials

Clinical trials are crucial in identifying effective drugs and determining optimal doses for lymphoma patients. Patients interested in participating in a clinical trial should talk to their physician or contact LRF's Helpline for an individualized clinical trial search by calling (800) 500-9976 or emailing helpline@lymphoma.org.

Follow Up

Because FL is generally characterized by multiple disease relapses after responses to a variety of treatments, patients in remission should have regular visits with a physician who is familiar with their medical history as well as with the treatments they have received. Medical tests (such as blood tests and computed axial tomography [CAT] scans) may be required at various times during remission to evaluate the need for additional treatments.

Some treatments can cause long-term effects or late effects, which can vary based on duration and frequency of treatments, age, gender, and overall health of each patient at the time of treatment. The doctor will check for these effects during follow-up care.

Lymphoma survivors should receive regular medical exams from a physician who is familiar with their medical history as well as the treatments they have received. Survivors and their caregivers are encouraged to keep copies of all medical records and test results as well as information on the types, amounts and duration of all treatments received. This documentation will be important for keeping track of any effects resulting from treatment or potential disease recurrences. For further information, please review our fact sheet on survivorship issues.

Support

A lymphoma diagnosis often triggers a range of feelings and concerns. In addition, cancer treatment can cause physical discomfort. Support groups and online message boards can help patients connect with other people who have lymphoma. One-to-one peer support programs, such as LRF's Lymphoma Support Network, match lymphoma survivors (or caregivers) with volunteers who have gone through similar experiences.

Resources

LRF offers a wide range of resources that address treatment options, the latest research advances, and ways to cope with all aspects of lymphoma. LRF also provides many educational activities, from in-person meetings to teleconferences and webcasts. For more information about any of these resources, visit the website at www.lymphoma.org or www.FocusOnFL.org. You can also contact the Helpline at (800) 500-9976 or helpline@lymphoma.org.

Webcasts/Podcasts

Teleconferences

In-person Educational Programs
Support Programs

View or order the following publications from our booklets/factsheets:

Lymphoma Helpline

Professional staff members are available to answer your questions and provide individual support to you and your loved ones. Contact our Helpline, available Monday through Friday from 8:00am - 5:00pm Pacific Standard Time (PST). Call (800) 500-9976 or e-mail helpline@lymphoma.org.