The role of "watch and wait" in intestinal follicular lymphoma in rituximab era

Scand J Gastroenterol. 2016 Mar;51(3):321-8. doi: 10.3109/00365521.2015.1087589. Epub 2015 Sep 18.


Objective: There is no consensus regarding the best treatment for intestinal follicular lymphoma (FL). We used "watch and wait" for patients with intestinal FL with low-tumor-burden (LTB) criteria and without mass formation causing bowel obstruction. We investigated the overall survival (OS) and time to treatment required (TTR).

Methods: Thirty-three intestinal FL patients [clinical stage (CS) I:16, II1:0, II2:7, IV:10; median observation period: 45.5 months, range: 13-110 months] were diagnosed via endoscopy. Detailed clinical and pathological examinations were performed, and neoplastic process behavior was monitored.

Results: All of the 33 patients were WHO grade 1. FL lesions in the digestive tract were found frequently in the second-fourth portion of the duodenum in 91% of the patients; 87% of those patients had lesions in a broader area including the small intestine. Two patients had an enlargement of the area of the lesions and a worsening of the macroscopic findings. Three patients had CS progression; however, these remained within the indication for "watch and wait." Two patients with transformation into diffuse large B-cell lymphoma received rituximab and chemotherapy, which led to complete remission. The OS was 100%. The time to treatment required (TTR) was 49 months in one patient and 37 months in one patient.

Conclusion: Intestinal FL in CS I-IV with broad infiltration of the digestive tract meeting the criteria for LTB had a remarkably slow course. This study suggests that "watch and wait" is appropriate for the treatment of LTB intestinal FL even in the era of rituximab.

Keywords: histologic transformation; intestinal follicular lymphoma; low-tumor-burden; treatment; watch and wait.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents / therapeutic use*
  • Disease Progression
  • Duodenal Neoplasms / drug therapy
  • Duodenal Neoplasms / pathology*
  • Duodenal Neoplasms / therapy*
  • Endoscopy, Gastrointestinal
  • Female
  • Humans
  • Lymphoma, Follicular / drug therapy
  • Lymphoma, Follicular / pathology*
  • Lymphoma, Follicular / therapy*
  • Lymphoma, Large B-Cell, Diffuse / drug therapy
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Rituximab / therapeutic use*
  • Survival Rate
  • Watchful Waiting*


  • Antineoplastic Agents
  • Rituximab