Chapter 6 - Treatment of relapsed follicular lymphoma

Abstract

Follicular lymphoma (FL) is the second most frequent subtype of non-Hodgkin’s lymphoma, and, as the most common indolent lymphoma, it represents the paradigm of indolent lymphomas. It is characterized by a typical pattern of responses followed by relapses or progressions, and although the outcome of patients with FL has significantly improved in the last decades (principally thanks to the introduction of anti-CD20 monoclonal antibodies), this is a disease that is still considered incurable in 2022 (at least with conventional chemotherapy). Thus, the expectation when treating patients with FL is that they will relapse, so thinking ahead of future treatment options is generally recommended. The knowledge on the biology of FL has significantly increased in the last years and this has led to the introduction of multiple new targeted drugs, expanding the number of treatment options. However, patients with FL are often asymptomatic, even at relapse, so preserving and optimizing a good quality of life by not overtreating patients is of utmost importance. In contrast, there are subsets of patients with a distinctly worse prognosis, such as those who experience an early relapse or those with histological transformation, and, if fit for it, they should be treated more intensively.