Follicular Lymphoma: No Clear Path, But Many Options
- Follicular lymphoma is often slow-growing, and many patients don’t need treatment right away. Watchful waiting is a common and safe approach.
- When treatment is needed, the approach will vary from patient to patient — and there have been many recent developments, including targeted treatments, immunotherapies, cellular therapies, and antibody drug conjugates.
- When cancer returns after treatment, or relapses, doctors are moving more towards targeted and immune-based therapies instead of chemotherapy in many cases. Newer options like CAR T-cell therapy and bispecific antibodies each offer their own benefits and tradeoffs in the relapse stage.
- Shared decision-making is key, with choices guided not just by effectiveness, but by quality of life, convenience, and patient preference.
Because of the uncertain way the disease can behave, there is no one size fits all approach to treatment.
Read MoreTreatment v. ‘Watchful Waiting’
After a follicular lymphoma diagnosis, doctors may recommend watchful waiting, or closely monitoring the disease instead of treating it.
“Studies showed survival was the same whether patients were treated early or observed,” Dr. Gaballa explains, adding that some patients, about 30%, can continue this watchful waiting approach and never need treatment.
Treatment typically begins only when the disease begins to cause symptoms or appears to be growing.
When treatment is needed, the approach will vary from patient to patient. While there is no clearly defined path, there have been a lot of recent developments.
“In the last five years we’ve had a tremendous amount of progress where there’s a lot of options, including targeted treatments, immunotherapies, advanced immunotherapies, cellular therapies, antibody drug conjugates, and those are reshaping how we’re treating these diseases,” Dr. Gaballa says.
Options For Relapse
When cancer returns after treatment, or relapses, doctors are moving more towards targeted and immune-based therapies instead of chemotherapy in many cases, Dr. Gaballa says.
Two of the most important newer treatments for relapse include:
- CAR T-cell therapy: A one-time, intensive treatment that requires preparation, time off, and close monitoring, but can be highly effective
- Bispecific antibodies: A less intensive and more flexible option that is given over time, often for several months
At this time, there is no clear “best” choice and no fixed order for using these treatment options.
“We do not have any trials comparing CAR T-cell therapy to bispecific antibodies,” Dr. Gaballa says.
For many patients, the decision comes down to how these treatments fit into their lives, as well as timing. These treatments are often used at different points, and many patients may receive both over the course of their care.
“There’s not going to be a one-size-fits-all,” Dr. Gaballa says.
Patient preferences matter as well.
“In aggressive lymphomas, we focus mostly on efficacy,” Dr. Gaballa explains. “But in follicular lymphoma…we look at safety, convenience, and what works for the patient’s life.”
Questions To Ask Your Doctor
- Do I need treatment right now, or is watchful waiting an option?
- What are my treatment options at this stage?
- How do we decide which treatment to use first?
- Should I consider CAR T-cell therapy or bispecific antibodies?
- Am I eligible/able to get CAR T-cell therapy?
Learn more about SurvivorNet's rigorous medical review process.
