Follicular lymphoma

Abstract

Follicular lymphoma is the most common and well-characterized lowgrade lymphoma. Gene expression pro filing and biomarker development have improved our understanding of its biology, but there remains no robust biologic, immunohistochemical prognostic marker at diagnosis. Therefore, clinical criteria such as the Follicular Lymphoma International Prognostic Index (FLIPI) and the GELA/BNLI criteria for starting treatment remain the most useful tools to both assign prognosis and commence therapy. Our better understanding of the heterogeneity of follicular lymphoma is paralleled by the development of a plethora of new first-line treatment options using monoclonal antibodies, either alone or in combination with chemotherapy or radio-conjugates. Emerging data supports the influence of depth of response to first-line therapy on long-term outcomes, and there is early evidence suggesting that rituximab maintenance therapy prolongs both progression- free and possibly overall survival. Improved patient understanding of this usually chronic and incurable disease is increasingly associated with a willingness to participate in treatment decision making. Thus, the selection of therapy at each phase of the disease, with subsequent impact on future therapeutic options, becomes a more sophisticated individualized process.