About one in five people coping with non-Hodgkin’s lymphoma are diagnosed with a type known as follicular lymphoma. Because there are different treatment approaches, many people affected by this diagnosis respond well to treatment and are able to manage their condition as a chronic illness. Learning about follicular lymphoma treatment approaches and ways to manage side effects will help you feel empowered and improve your quality of life.

Factors for Determining Treatment

After you are diagnosed with follicular lymphoma, your doctor may run blood tests, bone marrow tests and CT and/or PET scans. The results will help determine the stage of your cancer and whether or not you need treatment right away. Follicular lymphoma has four stages. It is “slow growing,” which means it can spread to other areas of the body before it is diagnosed. As a result, many patients are diagnosed at stage 3 or stage 4.

While the stage of your cancer is important, it is not the only piece of information that will help your doctor determine your prognosis and treatment. He or she will examine several factors, including your age, the number of lymph nodes that are affected and your blood test results. If you have symptoms such as fever, chills, weight loss, low blood count or enlarged lymph nodes in various sites, your doctor may start you on therapy.

If you have symptoms such as fever, chills, weight loss, low blood count, or a mass of enlarged lymph nodes in various sites, your doctor may start you on rituximab (Rituxan).

Not every patient with follicular lymphoma needs treatment, however. If you do not have any symptoms and your blood count is within normal range, your doctor may suggest observing your lymphoma until it starts to affect your quality of life. This is often referred to as “watch and wait.” Some people with follicular lymphoma live for years without being on therapy. Talk to your doctor about choosing an approach that is tailored to your age and your health.

Treatment Approaches

There are a variety of treatments that are effective for patients living with follicular lymphoma. Talk with your health care team to find the best combination approach for you.

If treatment is the best option for you, your doctor may first put you on chemotherapy with rituximab. There are numerous different chemotherapy regimens that can be considered, with a range of features and side effects. You should discuss what to expect during treatment and potential side effects with your doctor. Rituximab, a monoclonal antibody therapy, is used with chemotherapy to improve its effectiveness. This treatment is generally well-tolerated by patients and can be combined with many types of chemotherapy or given alone in some situations.

If these approaches do not keep your lymphoma under control, your doctor may try other options including radiation therapy, other chemotherapy drugs and radio-labeled monoclonal antibodies such as tositumomab or ibritumomab tiuxetan. In some situations, stem cell or bone marrow transplantation is considered, and many therapies being studied in clinical trials may prove to be effective options for treating follicular lymphoma. For more infromation on bone marrow transplantation, read CancerCare’s fact sheet titled, “Bone Marrow Transplantation as a Treatment Option: What You Need to Know.

Managing Side Effects

Maintaining a good quality of life remains the main concern for follicular lymphoma patients. Before deciding on a treatment, talk to your health care team about potential treatment-related side effects.

A common side effect patients may experience is low blood counts—as part of the lymphoma or its treatment. This may cause fatigue, bleeding or risk of infection. If you develop a fever, tell your treatment team right away as it can be a sign of infection.

Occasionally, peripheral neuropathy can occur, which includes numbness, pain and tingling in the hands and feet. This side effect can be managed when discussed with your health care team early on in treatment. Slight changes in the doses of drugs or schedule of drugs can make a noticeable difference. If you are experiencing nausea, talk with your doctor or nurse about drugs that can help minimize this side effect. While some drugs for follicular lymphoma cause hair loss, often this side effect can be avoided.

In order to manage side effects, it is important to talk to your health care team if you notice any changes to your quality of life. Work with your team to find the right combination of drugs that work for you. By communicating with your team, you can work together to best manage your follicular lymphoma.

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Last updated November 29, 2016

The information presented in this publication is provided for your general information only. It is not intended as medical advice and should not be relied upon as a substitute for consultations with qualified health professionals who are aware of your specific situation. We encourage you to take information and questions back to your individual health care provider as a way of creating a dialogue and partnership about your cancer and your treatment.

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