Follicular Lymphoma

What is follicular lymphoma?

Follicular lymphoma (FL) is a type of non-Hodgkin lymphoma that develops from B cells, a type of white blood cell. It is the most common slow-growing, or indolent, form of non-Hodgkin lymphoma. FL often involves lymph nodes and may also involve the bone marrow or spleen. Some people have few or no symptoms when it is diagnosed.

Why might I not need treatment right away?

Because follicular lymphoma often grows slowly, some people who are not having significant symptoms may not benefit from starting treatment immediately. Your oncology team may recommend active surveillance, also called watchful waiting or observation. This does not mean your lymphoma is being ignored. Your care team will monitor you with regular visits and may use physical examinations, blood tests, imaging, or other testing when appropriate. Treatment can be started if the lymphoma begins causing symptoms or shows other changes that make treatment appropriate.

How is follicular lymphoma treated if I need treatment?

Treatment depends on factors such as where the lymphoma is located, whether it is causing symptoms, how much disease is present, previous treatments, and your overall health. Depending on the situation, treatment may include radiation therapy, antibody-based treatment, other medicines, or combinations of treatments.

Your oncology team will explain whether treatment is needed and which approach is most appropriate for you.

What should I expect during treatment?

Your experience will depend on the treatment you receive. Your care team may regularly check blood counts and other laboratory tests, monitor for side effects, and use imaging or other testing when appropriate to evaluate how the lymphoma is responding. Ask your oncology team which side effects are most likely with your particular treatment and which symptoms should prompt you to contact them.

Will I need maintenance treatment?

Some people with follicular lymphoma may be offered ongoing maintenance treatment after responding to their initial therapy to help keep the lymphoma under control for longer. For others, follow-up without maintenance treatment may be preferred. The potential benefits and downsides depend on your previous treatment, response, side effects, infection risk, and individual goals.

Your oncology team can help you decide whether maintenance therapy is appropriate for your situation.

Can follicular lymphoma change over time?

Follicular lymphoma is usually slow-growing, but in some people it can transform into a faster-growing lymphoma, most commonly diffuse large B-cell lymphoma (DLBCL). Your oncology team watches for changes that might suggest the lymphoma is behaving differently.

Tell your care team about significant new changes such as a rapidly enlarging lymph node, unexplained fever, drenching night sweats, unintentional weight loss, or other new or worsening symptoms.

What happens during long-term follow-up?

Follicular lymphoma often requires long-term monitoring. Depending on your situation, you may be followed during active surveillance, after treatment, or while receiving maintenance therapy. Follow-up may include clinic visits, physical examinations, blood tests, and imaging when appropriate. Your oncology team will monitor for changes in the lymphoma, treatment effects, infections, and other health concerns over time.

Could a clinical trial be an option for me?

Clinical trials are research studies that evaluate new treatments or new ways of using existing treatments. Depending on the study, a clinical trial may be available at different points in your care. Participation is voluntary, and each trial has specific eligibility requirements.

Your oncology team can help you understand whether a clinical trial may be appropriate for your situation.

What are CAR T-cell therapy and stem-cell transplant?

CAR T-cell therapy uses your own T cells, which are collected and modified in a laboratory to recognize and attack lymphoma cells.

Stem-cell transplantation allows doctors to give intensive treatment followed by healthy blood-forming stem cells. In an autologous transplant, your own stem cells are collected and later returned to you.

These treatments are not needed or appropriate for every patient. Your oncology team will explain whether either option is relevant to your situation.