Even though follicular lymphoma responds well to treatment, it’s likely to return, or relapse. You’ll need more treatment. But between courses, you're likely to feel well for long stretches.
Your doctor's goal is to keep your cancer in check for as long as possible while making sure you have the least amount of side effects.
So what does a treatment cycle look like in follicular lymphoma?
What’s Watch and Wait?
Follicular lymphoma is a slow-growing form of B-cell non-Hodgkin's lymphoma. If you're mostly symptom-free, your doctor may decide to keep a close eye on you instead of starting treatment. This is called the "watch and wait" strategy, or active surveillance.
You might never need treatment. Or it could be months or years before your cancer advances enough to need it.
You'll still see your doctor for regular checkups, lab work, and imaging tests. These will show if anything has changed with your disease or if you need to start treatment. If you’re symptom-free, your doctor may want you to take antibody treatment (with rituximab) for a short period. These may allow you to put off chemotherapy for a while.
Some research shows that those who use the watch and wait strategy have similar life spans as those who get treatment early on in their disease.
What’s Active Treatment?
If you have lymphoma symptoms, or tests show your disease has gotten worse, you'll begin active treatment. Your doctor will decide which type based on the stage of your illness and your symptoms. Here's a look at those:
Stage I and early stage II
These are when your disease is in one lymph node group or in two areas near your diaphragm. Your doctor might suggest radiation therapy. Other options include a combination of chemotherapy and a monoclonal antibody (rituximab or obinutuzumab), or rituximab on its own followed by radiation therapy.
Stages III and IV
The usual treatment for these more advanced stages is a monoclonal antibody along with chemotherapy. Your lymph nodes may be very swollen, and you may also need radiation to ease your symptoms.
Your health care team will consider these things when making your treatment plan:
- The area of your body where the lymphoma is growing
- The size of the lymphoma
- Your symptoms
- Your blood test results
- Your overall health
- Your age
- How you feel about treatment
What’s Maintenance Therapy?
After treatment, your cancer may go into remission. That means your lymphoma is smaller or it’s gone away completely.
As part of your follow-up, your doctor may suggest you have maintenance therapy with monoclonal antibodies for up to 2 years. This can help lessen your odds of a relapse and help you live longer. But it can cause side effects.
In the meantime, you'll have regular checkups with your doctor to make sure you're getting better and don't have lymphoma symptoms. You might also have blood tests and scans if you show any signs of it.
What if It Returns or Doesn't Get Better?
Even with treatment, your follicular lymphoma is likely to come back. You may need another course of treatment. You also may need a biopsy and scans to figure out if your cancer has changed to a fast-growing form, and to know which stage your cancer is in.
If your initial treatment doesn't work or it doesn't last very long, it’s "refractory" lymphoma. Other treatments can help at this point to try to put your cancer into remission.
Your treatment for refractory follicular lymphoma may look the same as your first treatment. These may include chemotherapy, radiation, targeted drugs, and monoclonal antibodies.
You might also have a type of immunotherapy called CAR T-cell therapy.
If it looks like your treatment isn’t working, your doctor might suggest a stem cell transplant.
During this treatment, your damaged bone marrow stem cells are replaced with healthy ones. Your stem cells may have been damaged or destroyed by the chemotherapy you had.
While a stem cell transplant can help extend your time in remission, it's not for everyone. It's an intense procedure, so you’ll need to be in otherwise good physical health. If you have it done, you’ll need several months to heal.
