Determining which follicular lymphoma treatment options to go with—and when to go with them—is not an easy process because follicular lymphoma (FL) is such an indolent or slow-growing cancer. Doctors and patients have to balance their symptoms and the stage of their disease with considerations concerning become resistant to certain drugs and over-treating a cancer that may or may not require any action. Ultimately, the determination will depend on a variety of factors, ranging from the patient's age to their overall health to the molecular nature of the disease itself and more.
Radiotherapy Follicular Lymphoma Treatment
For patients with early-stage FL, the first course of follicular lymphoma treatment is often receiving involved-field radiation, or radiotherapy. Often, for stage I or II patients, radiation is all that is required and the follicular lymphoma treatment is enough to put their disease into remission for a significant amount of time before they require further follicular lymphoma treatment.
Chemotherapy and Immunotherapy Follicular Lymphoma Treatment
For some patients, chemotherapy is the first-line treatment for FL. Some of the regimens used include:
- Bendamustine + Rituxan
- CHOP or R-CHOP
- R-CVP (cyclophosphamide, vincristine, prednisone and Rituxan)
- Fludarabine + Rituxan
- FND-R (fludarabine, mitoxantrone, dexamethasone and Rituxan)
- Single-agent Rituxan
Second-line chemotherapeutic follicular lymphoma treatment includes:
- FCM-R (fludarabine, cyclophosphamide, mitoxantrone and Rituxan)
- Single-agent Rituxan maintenance
- High-dose chemotherapy followed by hematopoietic stem cell transplantation
Single-agent Rituxan is also known as maintenance therapy, and is a common follicular lymphoma treatment option for many FL patients.
Watch and Wait Follicular Lymphoma Treatment
Also known as watchful waiting, the 'watch and wait' option makes reference to giving the patient no direct treatments at all—rather, they simply keep an eye on the progress of their follicular lymphoma, and when the disease becomes symptomatic, then other follicular lymphoma treatment options are applied. Typically when a patient is put on Watch-and-Wait it is because their disease is asymptomatic, and not worsening or affecting their lives. Doctors tend to prefer not to expose a person to toxic chemotherapy or radiation when the follicular lymphoma treatment is not likely to be very effective against a slow-growing disease and in fact might do more harm than good.
Combination Follicular Lymphoma Treatment
Because FL is an indolent disease, it is uncommon for FL patients to die from this cancer. Rather, the disease becomes one that requires management for the remainder of their lives following diagnosis, and that management could take the form of some radiation, some chemotherapy, some immunotherapy, periods without any follicular lymphoma treatment at all (watching and waiting), perhaps even a clinical trial at some point.
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