Treating follicular lymphoma

NICE did not look at treatments for stage 1 follicular lymphoma. Ask your care team if you would like more information, or see where can I find out more?

Stage 2A follicular lymphoma

If you have stage 2A follicular lymphoma in 1 area of your body ('localised'), you should be offered radiotherapy as your first treatment.

Radiotherapy is not suitable for everyone. If it isn't right for you, and your lymphoma is not causing symptoms, your care team may advise a period of watch and wait before starting treatment.

If you are having symptoms, you should be offered treatment – ask your care team about treatment options.

Stage 3 or 4 follicular lymphoma

Many people have stage 3 or stage 4 (advanced‑stage) follicular lymphoma when they are diagnosed, but not everyone has symptoms. If you are symptom‑free you can stay well for longer before needing chemotherapy by taking a drug called rituximab.

If you do have symptoms you should be offered chemotherapy with rituximab. If your lymphoma improves after this treatment you may then be offered ongoing regular treatment with rituximab – this is called 'rituximab maintenance'.

Follicular lymphoma that comes back after treatment

If your lymphoma comes back you will usually be offered more treatment with chemotherapy and rituximab. Your care team will look at the treatment you had last time to help decide what would work best.

If your lymphoma improves after treatment and you are well enough, you should be offered high‑dose chemotherapy, which helps to kill any cancer cells left in your body, followed by a stem cell transplant (as long as you haven't had a transplant before). This is called 'consolidation' treatment.

Transformed follicular lymphoma

Follicular lymphoma is a low-grade lymphoma, but sometimes it can start to grow more quickly and turn into a high-grade lymphoma. This is called 'transformed' follicular lymphoma (see lymphoma that changes from low-grade to high-grade for more details).

Your care team will talk to you about the best treatment for transformed follicular lymphoma. Depending on how it responds to 1 or more rounds of chemotherapy, you may be offered high‑dose chemotherapy with a stem cell transplant.

Questions you could ask about treating follicular lymphoma

  • Why are you advising we watch and wait before starting treatment?

  • What is rituximab – is it suitable for me?

  • What is high‑dose chemotherapy?

  • If I am not well enough to have high‑dose chemotherapy or choose not to have it, what options can you suggest?

  • Is a stem cell transplant suitable for me? What type of transplant could I have?

  • What happens if my follicular lymphoma transforms into a high‑grade lymphoma?

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