The goal of follicular lymphoma treatment is to put your disease into remission. That means your symptoms, and signs doctors look for on scans, diminish or disappear.
You can stay in remission for many years. But it’s common for this cancer to come back, or relapse.
It may come and go several times. Fortunately, there are ways to manage your relapses. And each time your follicular lymphoma comes back, your doctor will treat it.
How Will I Know My Lymphoma Has Relapsed?
You’ll have checkups every few weeks or months after your lymphoma treatment first ends, and then less frequently as time goes on. During these visits, they'll check you for possible relapse.
Between those visits, you can watch for any symptoms. They might look like the ones you had when your cancer was first diagnosed, including:
- Swollen lymph nodes in your neck, armpits, or groin
- Fever
- Night sweats
- Unplanned weight loss
About 1 in 5 people with follicular lymphoma have an early relapse, which means their cancer comes back within 2 years of diagnosis or treatment. In general, the longer you stay in remission before relapsing, the better your outlook is.
What Happens When You Relapse?
Your doctor will do some tests before confirming that your cancer has relapsed. These might include imaging tests like X-rays, magnetic resonance imaging (MRI), or computed tomography (CT) scans. They might do another biopsy of your cancer cells, which removes a sample of fluid from your lymph node or bone marrow to test in a lab.
Your doctor might also check whether your cancer has gone through a change, or transformation. Follicular lymphoma can change from a slow-growing type to a fast-growing type. That only happens in about 2% to 3% of people with this cancer. If that happens, it can affect your outcome and you may need more aggressive treatment.
How Does Your Doctor Choose Your Next Treatment?
The best treatment approach isn't the same for everyone who relapses. Your doctor will help you decide your next steps based on factors like:
- Your age and health
- Which treatments you had before
- How your cancer responded to those treatments
- How long you were in remission
- Whether you had any side effects from past treatments
- Your treatment goals
If you were in remission for a few years before relapsing, your treatment might be the same as what you had before. But if your cancer came back within a couple of years, it could mean it was resistant to treatment. Your doctor might try a new treatment, such as a stem cell transplant or targeted medicine.
What Are Your Treatment Options After a Relapse?
They can include different combinations of medicines like these:
- Chemotherapy: powerful drugs that kill your cancer cells and stop them from dividing
- Immunotherapy: drugs that boost your immune system so it can attack your cancer
- Targeted therapy: This usually includes rituximab (Rituxan), a medicine that attaches to a protein called CD20 on the surface of your cancer cells to kill them. It’s often used with other chemotherapy
A stem cell transplant might be an option if you had an early relapse and you're otherwise healthy enough for it. First, you get high-dose chemotherapy to kill lots of cancer cells. Chemo damages some of the healthy young blood cells called stem cells in your blood marrow, along with cancer cells. You'll get an infusion of healthy stem cells to replace the ones that chemo damaged.
Your doctor will choose one of these two types of stem cell transplants:
- An autologous stem cell transplant, which uses stem cells taken from your bone marrow before you have chemo.
- An allogeneic stem cell transplant, which uses stem cells from a donor who is matched to you.
There are also a few new medicines that can help treat relapsed follicular lymphoma. Obinutuzumab (Gazyva) is a monoclonal antibody like Rituxan. Both target the protein CD20 on the surface of lymphoma cells. Another class of drugs called PI3K inhibitors interfere with signals that the cancer cells need to survive.
CAR T-cell therapy is a new type of treatment that trains your immune cells to find and attack your cancer.
First, your doctor takes a sample of infection-fighting immune cells called T cells from your blood. A lab changes those T cells to make them better cancer fighters. The lab then multiplies those altered T cells, which then go back into your blood to attack your cancer.
Tisagenlecleucel (Kymriah) is a CAR T-cell therapy that's approved to treat relapsed or treatment-resistant follicular lymphoma.
What About Palliative Care?
This isn’t a treatment, but it’s a program that keeps you comfortable. It also helps you manage the stress of living with cancer, and it helps improve your quality of life.
People often confuse palliative care with hospice care, but they aren't the same. Hospice care is given at the end of life. You can get palliative care alongside cancer treatment.
A typical palliative care program includes:
- Treatments to reduce your pain and relieve your cancer symptoms
- Emotional and spiritual support
- Physical therapy and occupational therapy to make your daily tasks easier
- Financial advice on managing the cost of your treatments
Should You Join a Clinical Trial?
You have a lot of options for treating relapsed follicular lymphoma. But if you've tried a few therapies and your cancer keeps coming back, or you'd like to try something different, you might want to take part in a clinical trial.
These studies test out new treatments and combinations of existing treatments. Enrolling in one may give you a chance to try something new and possibly more effective before it's available to everyone else.
Ask your doctors about enrolling in a clinical trial. They’ll help you understand how it might help you. Also ask what side effects any new treatments in the study could cause, and what (if any) costs you'll have to pay out of pocket.
