How I treat early relapsing follicular lymphoma

Carla Casulo and Paul M. Barr


Follicular lymphoma (FL) is the most frequently occurring indolent non-Hodgkin lymphoma with generally favorable outcomes, but a variable clinical course. Recent studies have elucidated the consistent and reproducible frequency of early disease progression in FL, occurring in approximately 20% of patients. Relapse of FL within 24 months of chemoimmunotherapy (POD24) is now established as a robust marker of poor survival, leading to increased risk of death. Currently there is no established method of identifying patients at risk for early disease progression at the time of their FL diagnosis. However numerous studies worldwide are investigating clinical, pathological, and radiographic biomarkers to help predict POD24, to improve subsequent outcomes and adapt therapy based on individual risk. There is also a paucity of standardized treatments for patients with POD24, but investigations are ongoing testing novel targeted therapies and autologous stem cell transplant strategies. This review provides an overview of early relapsing FL and our approach to patient management based on recent available data.

  • Submitted August 3, 2018.
  • Accepted January 24, 2019.