What Are the Treatment Options for Follicular Lymphoma?

Follicular lymphoma is an indolent subtype of lymphoma that has several treatment options depending on a patient’s symptoms, stage of disease, age, and more. Patients without symptoms may not need treatment. In these cases, doctors will actively monitor the patient for any signs and symptoms related to the disease. Once the patient experiences symptoms, their doctor will inform them of the treatments available to them. For patients with follicular lymphoma, the prognosis is usually favorable as the cancer develops more slowly than other lymphoma subtypes.

What is Follicular Lymphoma?

Follicular lymphoma is the most common type of indolent (slow growing) non-Hodgkin’s lymphoma, which begins in B-lymphocytes. Because of this, Follicular lymphoma is also known as follicular B-cell lymphoma. Lymphoma is a cancer of the lymphatic system which includes the lymph nodes, the spleen, thymus gland, and bone marrow. Over time, follicular lymphoma may spread to the bone marrow, spleen, and other surrounding tissues. The average age at diagnosis of follicular lymphoma is 50 years old. In some rare cases, follicular lymphoma can develop into a more aggressive subtype of lymphoma, such as diffuse large B-cell lymphoma if symptoms are not treated.

What are The Symptoms of Follicular Lymphoma?

At the time of diagnosis, follicular lymphoma symptoms are often not experienced by patients because follicular lymphoma progresses slowly. However, symptoms often develop over time in these cases. For those who do experience symptoms, they are similar to other types of lymphoma, which include:

Painless lump in the neck, groin, or armpit
Fatigue and shortness of breath
Night sweats
Unexpected weight loss

How is Follicular Lymphoma Diagnosed?

Doctors will often check for swollen lymph nodes on a patient’s body to screen for lymphoma, specifically in the neck, armpits, and groin. Doctors often recommend a biopsy on a lymph node to see what types of cells are present. Also, bone marrow from the hip can be taken to look at any present lymphoma cells. To look for lymphoma cells in other parts of the body, imaging tests can be done. These tests include an MRI, CT scan, or PET (Positron Emission Tomography) scan.

What are The Treatment Options for Follicular Lymphoma?

Follicular lymphoma treatment depends on several factors in patients such as the stage of disease, the patient’s age, and previous treatments used.

Treatment options for follicular lymphoma include:

Chemotherapy
Monoclonal antibodies
Bone marrow transplant
Targeted therapies
CAR T-Cell Therapy and other immunotherapies

Monoclonal Antibodies

Monoclonal antibodies are proteins of the immune system created in a laboratory to treat cancer. These antibodies bind to specific targets on cancer cells to prevent them from performing vital cell functions to help stop the growth and spread of cancer.

Common monoclonal antibodies in lymphoma include:

Rituximab: used to treat different types of non-Hodgkin’s lymphoma
Obinutuzumab: used to treat follicular lymphoma
Mogamulizumab: used to treat relapsed or refractory T-cell lymphomas

Chemotherapy

Chemotherapy is an anti-cancer drug that is typically injected into a vein or taken orally. These drugs enter the bloodstream and reach almost everywhere throughout the body, making this treatment very useful specifically in lymphoma. Chemotherapy is one of the most common treatments in all types of lymphoma. In follicular lymphoma, chemotherapy is often combined with a monoclonal antibody.

Maintenance Therapy

Maintenance therapy is a long-term treatment for indolent cancers that can last several years. The goal of this therapy is to reduce the risk of recurrence and maintain any lymphoma cells that may be left in the body. This treatment is often given to patients who have completed their initial course of treatment and are currently in remission. Monoclonal antibodies are often used in follicular lymphoma as maintenance therapy.

CAR T-Cell Therapy

CAR T-cell therapy is a type of immunotherapy in which a patient’s T-lymphocytes are altered in a laboratory so they will bind to cancer cells and prevent them from performing vital cell functions. Patient’s white blood cells are removed through a tube and then combined with a chimeric antigen receptor (CAR) before being returned to the patient. The CAR T cells then bind to an antigen on the cancer cells and kill them.

Treatments: Early Stages

In early stages, some patients will not receive treatments until they experience symptoms. Active monitoring by doctors helps patients living with follicular lymphoma start treatment as soon as needed. Treatment without symptoms may cause more harm to a patient’s body than good. The first treatment offered to patients in the early stages is radiation to prevent the spread of disease, followed by a mono clonal antibody, or chemotherapy with a monoclonal antibody. The treatment of lymphoma in early stages is less complicated than advanced stages, where some patients opt for clinical trials to access the latest treatment options that are still seeking approval from the FDA.

Treatment: Advanced Stages

In advanced stages, the most common treatment for patients is a monoclonal antibody, most often rituximab or Obinutuzumab, combined with chemo. If one or more of the lymph nodes are enlarged, radiation may be used to reduce any symptoms that are present. Radiation may also be used in patients who are not physically fit enough for chemotherapy.

If the tumor shrinks or the patient goes into remission, doctors still advise some patients to be actively monitored or continue using a monoclonal antibody for a few years. This decreases the likelihood of the disease returning but can cause negative side effects in some cases. If the patient does not respond to the first-line treatment, they may be treated with a different combination of drugs, including CAR T-cell therapy, targeted therapies, or different chemotherapy drugs than used previously.

Follicular Lymphoma Clinical Trials

Clinical trials offer treatment options for follicular lymphoma before they are widely available while the drugs go through the FDA approval process. There are over 800 clinical trials active in the United States for lymphoma. Participating in a clinical trial not only progresses much needed research but also gives patients access to these innovative therapies years before the general population.

Current lymphoma clinical trials are researching new:

Targeted therapies for new biomarkers
Combinations of chemotherapies with other drugs
Immunotherapy drugs, such as CAR T-cell therapy
Monoclonal antibodies

Massive Bio’s Artificial Intelligence (AI) powered Clinical Trial Matching System connects patients and their treating oncologists to clinical trials according to their unique cancer case.

Sources:

https://lymphoma.org

https://www.cancer.gov