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Follicular lymphoma is a type of non-Hodgkin lymphoma that develops when the body makes abnormal B-lymphocytes – the lymphoma cells. These abnormal cells usually develop in the lymph nodes but can affect other parts of the body. Follicular lymphoma is a slow-growing or 'indolent' lymphoma. It is the most common type of slow-growing non-Hodgkin lymphoma. There are several treatment options available for follicular lymphoma, which can help manage the disease and alleviate symptoms. The choice of treatment depends on the stage of the disease, the patient's overall health, and their personal preferences.

1. Watchful Waiting

Watchful waiting, also known as active surveillance, may be recommended for patients with follicular lymphoma who do not have any symptoms. This approach involves closely monitoring the patient's condition without giving treatment until symptoms appear or change. The aim is to avoid unnecessary side effects of treatment for as long as possible.

2. Chemotherapy

Chemotherapy is a common treatment for follicular lymphoma. These drugs kill cancer cells or stop them from growing. Chemotherapy works by interfering with the ability of rapidly growing cells, like cancer cells, to divide or multiply. The specific drugs used in chemotherapy for follicular lymphoma may include cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP). People with stage II to IV disease are generally treated first with chemotherapy plus anti-CD20 antibodies like rituximab, sometimes called chemoimmunotherapy or R-CHOP.

3. Immunotherapy

Immunotherapy is a type of treatment that uses the body's immune system to fight cancer. In the case of follicular lymphoma, monoclonal antibodies like rituximab or obinutuzumab may be used. These are medications that target a particular protein called CD20 that is found on the surface of cancer cells. Because the anti-CD20 antibodies specifically target cancer cells, they have advantages over other cancer treatments like chemotherapy, which targets all rapidly growing cells, even healthy ones. There are usually fewer side effects and long-term risks associated with anti-CD20 antibody therapies than with traditional chemotherapy. CAR T-cell therapy is also another immunotherapy option. This therapy reprograms T-cells to attack cancer cells. Axicabtagene ciloleucel (Yescarta) and tisagenlecleucel (Kymriah) are CAR T-cell therapy options for follicular lymphoma. 

4. Radioimmunotherapy

Radioimmunotherapy combines immunotherapy and radiation therapy. A radioactive substance is attached to a monoclonal antibody, which directs the radiation to the cancer cells. Zevalin (ibritumomab tiuxetan) is a drug used in this type of treatment for follicular lymphoma, specifically for patients with relapsed or refractory disease or for those who achieved a partial or complete response to first-line chemotherapy. 

5. Radiation Therapy

Radiation therapy uses high-energy rays to kill cancer cells. This treatment may be used for follicular lymphoma if the disease is localized to one group of lymph nodes.

6. Stem Cell Transplant

A stem cell transplant, also known as a bone marrow transplant, may be an option for patients with follicular lymphoma if other treatments are not effective. This procedure involves replacing the patient's diseased bone marrow with healthy stem cells, which can grow into new bone marrow.

7. Clinical Trials

Clinical trials are not just a last resort for treating follicular lymphoma. They can actually provide access to cutting-edge treatments that are not yet approved but show promise over years of testing. The choice of a clinical trial depends on a variety of factors including the patient's age, overall health and the stage of follicular lymphoma. It's important to discuss all treatment options, including goals and possible side effects, with your healthcare team to help make the best decision. To learn more about your follicular lymphoma clinical trial options, visit HealthTree's Follicular Lymphoma Clinical Trial Finder. Utilize the advanced filter option to locate trials that you are eligible to participate in. You can create a HealthTree account to favorite your top trial options so you can discuss them with your follicular lymphoma specialist.

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