The Fellow on Call: The Heme/Onc Podcast Episode 137: Follicular Lymphoma Series, Pt 2. - Front-line Management
Jun 25, 2025
This discussion dives deep into front-line therapies for follicular lymphoma. It unpacks management strategies for both localized and diffuse disease, assessing treatment options for symptomatic versus asymptomatic patients. The impact of rituximab therapy is evaluated, with insights from the PRIMA trial. The conversation also highlights the evolving understanding of lymphoma classifications and the role of personalized care in improving patient outcomes. Historical studies shape today's decisions, making it a compelling exploration of treatment approaches.
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Stage 1 Follicular Lymphoma Management
- For stage 1 follicular lymphoma, either observe if asymptomatic or treat with radiation for local control.
- Radiation may not improve survival but can provide durable remission and reduce future chemotherapy need.
Observation is a Valid Approach
- About half of follicular lymphoma patients never need treatment during their lifetime.
- Observation resulted in overall survival similar to early chemotherapy in low tumor burden cases.
Treating Asymptomatic Advanced Disease
- For asymptomatic advanced follicular lymphoma without high tumor burden, consider observation or rituximab monotherapy.
- Use GELF and BLNI criteria to decide on systemic therapy with chemoimmunotherapy if criteria are met.