Treatment

• if localised disease treatment is with radiatiotherapy - upto 50% of localised disease may be cured
  • however less than 10% of patients with follicular lymphoma present with localised disease
    
    
• First-line treatment for stage IIA follicular lymphoma Treating advanced-stage asymptomatic follicular lymphoma Treating advanced-stage symptomatic follicular lymphoma Treating advanced-stage relapsed or refractory follicular lymphoma Consolidation with stem cell transplantation  
  • local radiotherapy is the first-line treatment to people with localised stage IIA follicular lymphoma
  • consider 'watch and wait' (observation without therapy) as first-line treatment for people with stage IIA follicular lymphoma who are asymptomatic and for whom treatment with a single radiotherapy volume is not suitable
  • if stage IIA follicular lymphoma who are symptomatic and for whom radiotherapy is not suitable then offer the same treatments that might be offered to people with advanced-stage (stages III and IV) symptomatic follicular lymphoma
    
    
  • rituximab induction therapy to people with advanced-stage (stages III and IV) follicular lymphoma who are asymptomatic
    
    
  • rituximab, in combination with:
    • cyclophosphamide, vincristine and prednisolone (CVP)
    • cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP)
    • mitoxantrone, chlorambucil and prednisolone (MCP)
    • cyclophosphamide, doxorubicin, etoposide, prednisolone and interferon-alpha (CHVPi) or
    • chlorambucil
      
      
  • rituximab
    • in combination with chemotherapy, is as an option for the induction of remission in people with relapsed stage III or IV follicular non-Hodgkin's lymphoma
    • rituximab monotherapy as maintenance therapy is as an option for the treatment of people with relapsed stage III or IV follicular non-Hodgkin's lymphoma in remission induced with chemotherapy with or without rituximab
    • rituximab monotherapy is an option for the treatment of people with relapsed or refractory stage III or IV follicular non-Hodgkin's lymphoma, when all alternative treatment options have been exhausted (that is, if there is resistance to or intolerance of chemotherapy)
      
      
  • consolidation with autologous stem cell transplantation should be offered for people with follicular lymphoma in second or subsequent remission (complete or partial) who have not already had a transplant and who are fit enough for transplantation
  • consolidation with allogeneic stem cell transplantation should be considered for people with follicular lymphoma in second or subsequent remission (complete or partial): who are fit enough for transplantation and for whom a suitable donor can be found and when autologous stem cell transplantation has not resulted in remission or is inappropriate (for example, because stem cell harvesting is not possible).

Reference:

• NICE (July 2016). Non-Hodgkin's lymphoma: diagnosis and management