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Follicular Lymphoma (short version)

Date of document March 2022
This is the current valid version of the document

1Summary

Follicular lymphoma is the most common indolent lymphoma. The WHO distinguishes between different grades. Follicular lymphoma grades 1-3A belong to the indolent, grade 3B to the aggressive lymphomas. Most common, clonal, genetic aberration is a balanced translocation t(14;18) with overexpression of BCL2 protein. This translocation is characteristic of follicular lymphoma but is not specific.

The clinical picture is characterized by a slowly progressive lymphadenopathy. It may persist for a long time without further clinical symptoms. The clinical course is highly variable. Survival times range from a few years to over two decades. Approximately 20% of patients have a more aggressive course with progression within 24 months of diagnosis. The vast majority of patients with follicular lymphoma are diagnosed at an advanced stage of disease. The Follicular Lymphoma International Prognostic Index (FLIPI) allows the differentiation of three groups with different prognosis.

Therapy is stage-dependent. In stage I (and localized stage II), irradiation of the affected lymph node regions has a curative claim. Drug therapy is initiated in the advanced stages when clinical symptoms are present. Remission rates of ≥80% are achieved with the combination of chemotherapy and an anti-CD20 antibody.

2Therapy

Figure 1: First-line therapy of follicular lymphoma. 
curative treatment intent; non-curative treatment intent;
1 RF - risk factors (LK ≥ 5-7 cm)
2 AZ - general condition;
3 watch & wait - wait-and-see behavior under regular observation;
4 Induction chemotherapy: see induction chemotherapies stage III/IV
5 cave: increased risk of opportunistic infections;
6 CVP - cyclophosphamide / vincristine / prednisone;
7 Rituximab monotherapy is a therapeutic alternative for patients who have a low tumor burden or who cannot tolerate immunochemotherapy.
8 CR - complete remission, PR - partial remission;
9 BSC - Best Supportive Care

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10Active studies

11Systemic Therapy – Protocols

12Study results

13Certification Status

15Authors' Affiliations

Prof. Dr. med. Christian Buske
Universitätsklinikum Ulm
Innere Medizin III
Inst. f. Experimentelle Tumorforschung
Albert-Einstein-Allee 11
89081 Ulm
Prof. Dr. med. Martin Dreyling
Klinikum der Universität München
Med. Klinik und Poliklinik III Großhadern
Marchioninistr. 15
81377 München
Prof. Dr. med. Klaus Herfarth
Universitätsklinikum Heidelberg
Radioonkologie & Strahlentherapie
Im Neuenheimer Feld 400
69120 Heidelberg
Prof. Dr. med. Michael Herold
Helios Klinikum Erfurt GmbH
Onkologisches Zentrum
Nordhäuser Str. 74
99089 Erfurt
Prof. Dr. med. Anna Lena Illert
Uniklinikum Freiburg
Klinik für Innere Medizin 1
Schwerpunkt Hämatologie und Onkologie
Hugstetter Str. 55
79106 Freiburg
Prof. Dr. Peter Neumeister
LKH-Universitätsklinikum Graz
Innere Medizin
Klinische Abt. f. Onkologie
Auenbrugger Platz 15
A-8036 Graz
PD Dr. med. Christian Scholz
Vivantes Klinikum Am Urban
Klinik für Innere Medizin,
Hämatologie und Onkologie
Dieffenbachstr. 1
10967 Berlin
PD Dr. med. Wolfgang Willenbacher
Universitätsklinikum Innsbruck
Innere Med. V
Hämato-Onkologie
Anichstr. 35
A-6020 Innsbruck
Prof. Dr. med. Thorsten Zenz
UniversitätsSpital Zürich
Zentrum für Hämatologie und Onkologie​
Rämistr. 100
CH-8091 Zürich

16Disclosures

Conflicts of interest can be found in the full German version of the guideline.

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