All About Follicular Lymphoma

Health Writer
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Follicular lymphoma is an indolent, or slow growing, lymphoma that starts in the B lymphocytes, white blood cells that make antibodies to fight infection. It accounts for between 20 and 30 percent of all non-Hodgkin’s lymphomas.


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Risk factors

There are a number of risk factors associated with non-Hodgkin’s lymphoma, although having a risk factor does not mean you will develop the disease. Some of the risk factors include:

  • Being a white male age 60 years or older
  • Having a parent, child, or sibling with NHL
  • Previous radiation exposure
  • Having a weakened immune system
  • Having an autoimmune disorder
  • Certain infections


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Symptoms

People with follicular lymphoma may have no obvious symptoms at the time of diagnosis. Some may notice enlargement, swelling, or pain in the area of the lymph nodes in the neck, armpit, abdomen, or groin. They may experience shortness of breath, night sweats, unexplained weight loss, and fatigue.


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To treat or not to treat

Since follicular lymphoma is slow growing, some cases do not require immediate treatment, which may be delayed until symptoms start causing problems. With active surveillance, doctors monitor the progress of the disease through imaging and examinations. If symptoms appear or the disease is progressing, they start treatment, usually radiation and chemotherapy. Early-stage follicular lymphoma sometimes goes into remission with radiation alone.


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Medications

Four medications have been approved by the FDA for the treatment of follicular lymphoma. They are

  • Copanlisib (Aliqopa)
  • P13K-delta and P13K-gamma inhibitor (Dubelisib)
  • Obinutuzumab (Gaszyva), an immunotherapy drug
  • Rituximab and hyaluronidase human (Rituxan Hycela), an immunotherapy drug


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Determining the best medication

A study published in the New England Journal of Medicine found the drug obinutuzumab may lead to longer periods of remission. After three years, 80 percent of those using this medication showed no sign of cancer progression or relapse, compared to 73 percent of those on rituximab. But obinutuzumab caused more side effects and severe allergic reactions. A few people developed other blood cancers. You and your doctor will need to consider which drug is best for you.


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Radioimmunotherapy

Radioimmunotherapy is sometimes used to treat follicular lymphoma that has relapsed, is treatment-resistant, or has responded in part or completely to first-line treatment. A small amount of radioactive material that is attached to a molecule and then injected into the person’s bloodstream. The molecule attaches to cancer cells and delivers a high dose of radiation to the tumor.


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Prognosis

Follicular lymphoma is not curable but instead is considered a long-term, chronic disease. The five-year survival rate is 80 to 90 percent and the median survival is 10 to 12 years after diagnosis.


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Transformed lymphoma

Some people with follicular lymphoma may develop a transformed lymphoma, which is more aggressive and requires intensive treatment. Because this is relatively rare, there are few studies to provide guidance on treatment. Close monitoring and follow up after treatment for follicular lymphoma may be necessary for prompt treatment if a more aggressive form of cancer develops.


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Can follicular lymphoma be prevented?

There is no sure-fire way to prevent non-Hodgkin’s lymphomas, including follicular lymphoma. Many risk factors, such as family history or having an autoimmune disorder, are not within your control. Others, such as radiation from other cancer treatment, have benefits that outweigh the risk. Some studies have found that obesity may raise your risk of developing these types of cancers. Eating a well-balanced diet and maintaining a healthy weight may help.