Managing newly diagnosed follicular lymphoma: state of the art and future perspectives

Abstract

Follicular lymphoma (FL) accounts for approximately 20% of all lymphomas and represents the prototype of 'indolent' lymphoma. Many patients enjoy a long period of asymptomatic and generalized lymphadenopathy, with slow clinical progression. For stage I FL and selected cases of stage II, the administration of definitive involved field radiation usually results in long-lasting remission and is still considered the treatment of choice. For advanced disease (stages III-IV), the treating physician is called to select therapy from several options. Because many patients are asymptomatic and have limited disease, clinical observation has been considered appropriate for selected patients. For patients in need of treatment, the systemic treatment has historically been based on chemotherapy; however, rituximab monotherapy or radioimmunotherapy have recently been shown to be effective enough to merit consideration. Moreover, there is considerable evidence to suggest that the first-line treatment should contain rituximab. Maintenance therapy with rituximab extends remission after chemotherapy in untreated patients and in patients who have relapsed. Newer promising treatments include anti-CD20 antibodies (or other surface antigens) engineered for greater efficacy, biological agents or vaccination therapy. This article presents an overview of the current therapeutic options for the management of newly diagnosed FL.