Review Article

Update on the Management of Follicular Lymphomas

Amy Goodrich, MSN, CRNP

From the Johns Hopkins Kimmel Cancer Center, Baltimore, Maryland

Ms. Goodrich has no financial relationships to disclose.

Correspondence to: Amy Goodrich, MSN, CRNP, Johns Hopkins Kimmel Cancer Center, 550 North Broadway, Suite 1003, Baltimore, MD 21205. E-mail:

J Adv Pract Oncol 2011;2(Suppl 2):27–34 | © 2011 Harborside Press®



Follicular lymphomas (FLs), the second most common type of non-Hodgkin lymphoma in the United States, are typically diagnosed in older patients. Grades 1 and 2 FLs, which account for about 75% of all FLs, are commonly indolent and incurable in most patients. Grade 3 FL is aggressive but may be curable. Diagnostic workup includes morphology, immunophenotyping, and, in some cases, molecular genetic analysis, cytogenetics or fluorescence in situ hybridization, and Ki67 testing. Staging workup includes physical examination, laboratory assessment, computed tomography scans, and bone marrow aspirate and biopsy. The Follicular Lymphoma International Prognostic Index allows stratification into low-, intermediate-, and high-risk disease and is widely used to predict outcomes and guide therapy. For patients with early-stage indolent FL, radiation therapy with or without systemic therapy is recommended. For those with advanced FL, observation is a common course of action since the goal of treatment is disease or symptom control. Once the decision to treat is made, several chemotherapy and immunotherapy regimens can be considered. Rituximab is a mainstay of treatment for indolent FL, and bendamustine is being studied alone or in combination regimens. Several novel agents, as well as hematopoietic stem-cell transplantation, are also under investigation. Side-effect prevention and management are essential for all patients undergoing FL treatment.

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