Follicular lymphoma is the most common indolent non-Hodgkins lymphoma diagnosed in the United States. Follicular lymphoma often grows slowly and can be present for many years without causing significant problems. Even in patients with advanced-stage disease, studies have shown that there is no survival advantage to treating follicular lymphoma at diagnosis compared with treating only when symptoms are present.1 Treatment is initiated when lymph nodes are sufficiently bulky that they cause pain or cosmetic problems or compromise adjacent organs, or when bone marrow involvement causes significant cytopenias. Other symptoms of follicular lymphoma that often necessitate treatment are fatigue, night sweats, anorexia, and unintentional weight loss. Follicular lymphoma responds very well to single-agent chemotherapy or combination chemotherapy regimens, including the monoclonal anti-CD20 antibody rituximab. High-dose therapy with autologous or allogeneic stem cell transplantation may prolong survival or even cure some patients, although most patients cannot tolerate these aggressive therapies and they are almost never utilized as an initial treatment option. Radiation is rarely utilized, except in localized disease.
- Close monitoring with repeat CT scans in 3 to
1. Horning SJ, Rosenberg SA. The natural history of initially untreated low-grade non-Hodgkins lymphomas. N Engl J Med 1984;311:1471-5.
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