There are several treatment options for people with follicular lymphoma, a type of cancer in which blood cells called lymphocytes grow abnormally. The choice of treatment depends on the rate of cancer growth and the severity of the symptoms. They include active surveillance, radiotherapy, chemotherapy, immunotherapy, radioimmunotherapy, and stem cell transplantation.
Active surveillance, also known as watchful waiting, is a strategy in which the patient’s condition is closely monitored or tracked without giving any treatment until lymphoma-related symptoms appear or change, since spontaneous partial regression, or the cancer regressing by itself, has been observed. For some patients active surveillance may continue for more than 10 years before treatment is needed, but it is appropriate only for patients with low tumor burden.
Chemotherapy is an anticancer treatment that uses drugs to stop the growth of cancer cells either by killing the cells or stopping them from dividing. It often consists of giving several anti-cancer drugs together (combination chemotherapy) in a defined way called a treatment regimen. Depending on the regimen, chemotherapy may be administered in pill form, as an injection, or as an intravenous drip. The method in which chemotherapy is given usually depends on the stage of the disease.
Chemotherapies used in the treatment of follicular lymphoma include bendamustine, CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone), CVP (cyclophosphamide, vincristine, and prednisone), and fludarabine (+/- mitoxantrone, +/- cyclophosphamide). Common combination regimens include R-bendamustine (rituximab and bendamustine), R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone), and R-CVP (rituximab, cyclophosphamide, vincristine, and prednisone).
Radiotherapy, also known as radiation therapy, is a cancer treatment that uses high-energy X-rays or other types of radiation to kill cancer cells in localized areas, such as the affected lymph nodes, and prevent cancer growth. It is used to treat patients with early-stage follicular lymphoma (stages I and II). The total dose of radiation is usually divided and given over one to six weeks. The treatment site must be carefully guarded against the sun during and after radiation therapy.
Immunotherapy is a treatment that either boosts the patient’s immune system or uses engineered molecules called monoclonal antibodies that bind to a specific target on the surface of lymphocytes (cells in which lymphoma starts). Once the monoclonal antibodies are bound to the target lymphocytes, they then can recruit the patient’s immune cells to destroy the cancerous cells. The monoclonal antibody rituximab is administered by infusion into veins and used to treat follicular lymphoma.
Radioimmunotherapy is a type of immunotherapy in which a radioactive substance is attached to the monoclonal antibody. When the monoclonal antibody binds to the target cells, the radioactive source destroys the cancer cells directly. Zevalin is one such treatment.
Stem cell transplantation
Stem cells are a type of progenitor cells that can give rise to different types of specialized cells. Follicular lymphoma can be treated by stem cell transplantation, which involves transferring healthy stem cells that give rise to lymphocytes, either from the patient’s body or from a donor. This approach results in a healthy blood-forming system, producing healthy red blood cells, white blood cells, and platelets.
There are three types of blood-forming stem cells — bone marrow cells, peripheral blood stem cells (PBSC) and cells collected from an umbilical cord after a baby is born. When stem cells are derived from the bone marrow, the procedure is called bone marrow transplantation. If the stem cells are extracted from the patient, radiation and chemotherapy are used in order to kill any cancerous cells.
Treatments under investigation
Many treatments are being tested in clinical trials for patients who are newly diagnosed or have relapsed or drug-resistant follicular lymphoma. The therapies under investigation include various combinations of several agents: rituximab, lenalidomide, bendamustine, ofatumumab, bortezomib, ibrutinib, duvelisib, TGR1202, obinutuzumab, atezolizumab, and pembrolizumab.
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