Standard treatment and future perspectives for follicular lymphoma

Abstract

Follicular lymphoma (FL) is the most common type of low-grade, non-Hodgkin lymphoma. Although FL is generally a chemo-sensitive disease, current treatment strategies cannot cure patients with advanced-stage FL. Therefore, FL patients experience remission and relapse many times and generally have a long clinical course. The treatment goals for FL focus on improving subjective symptoms, recovery of cytopenia, and improvement in the quality of life. Careful watch and wait is an important treatment for asymptomatic FL with a low tumor burden. Rituximab monotherapy is also an important option for patients who have mild symptoms. The standard treatment for FL with a high tumor burden includes a combination of anti-CD20 antibodies, like rituximab or obinutuzumab, and chemotherapy like bendamustine and CHOP. The group with poor prognosis FL, such as POD24, should be considered for high-intensity therapies that include hematopoietic cell transplantation. In recent years, the development of molecular targeted therapies for recurrent FL has been vigorously promoted. Recently, lenalidomide and tazemetostat have been approved in Japan. This manuscript outlines the treatment strategy for untreated and relapsed FL and discusses future issues.