Relapsed Follicular Lymphoma: Treatment Options and What to Expect

This article shares key points from a HealthTree webinar for people with follicular lymphoma with expert Dr. Carla Casulo, an oncologist at Wilmot Cancer Institute in New York. You will learn about relapse, treatment options, and new research. Watch the full webinar recording here. 

What is follicular lymphoma?

Follicular lymphoma is a type of blood cancer. It starts in white blood cells called lymphocytes. These cells help fight infections. Lymphocytes live in lymph nodes and travel through the body. Lymph nodes are small glands that help protect the body. When lymphoma develops, these cells grow out of control. They can build up in lymph nodes or other areas.

Starting with the basics can make it easier to understand your diagnosis and care.

What relapse and refractory mean

Relapse means the lymphoma returns after treatment. This can happen after a period called remission. Remission means there are no signs of lymphoma on tests or scans. 

Refractory lymphoma means the treatment did not work to control the cancer. The lymphoma may not shrink enough. 

Why follicular lymphoma comes back 

Lymphoma returns if cancer cells remain. Doctors use PET scans and CT scans to check for lymphoma, but these cells may not always show on scans. 

Relapse can happen after partial remission. Other times, it may happen after full remission. 

Do all patients need treatment at relapse?

Not always. Sometimes, medication is not needed right away. Doctors may use a watch-and-wait approach. This means close monitoring to see if lymphoma gets worse.

Watch-and-wait may be a safe option if there are no symptoms. It also depends on how the lymphoma behaves. Click here to learn when doctors recommend treatment for follicular lymphoma. 

“Not everyone with relapsed follicular lymphoma needs treatment right away.” - Dr. Casulo

How doctors choose treatment

Doctors look at several factors before choosing treatment:

• Overall health and support system
• Previous treatments used
• Time since last treatment
• Response to earlier treatments

These details help shape a treatment plan that fits your situation.

Common relapsed follicular lymphoma treatment options

Several treatments are available for people with relapsed follicular lymphoma:

• Chemotherapy is a treatment that damages cancer cell DNA. Chemotherapy can also affect healthy cells. This may cause side effects like fatigue or hair loss.
• Monoclonal antibodies are lab-created antibodies. They target a protein on lymphoma cells to remove them. One type used for follicular lymphoma is called rituximab.
• CAR T-cell therapy uses your own immune cells. The T cells are changed in a lab to target lymphoma. CAR-T is often used after multiple relapses. The available brands for follicular lymphoma include axi-cel (Yescarta, Kite), liso-cel (Breyanzi, Juno Therapeutics/BMS), and tisa-cel (Kymriah, Novartis).
• Bispecific antibodies bring immune cells and lymphoma cells together. This helps kill cancer cells. Bispecific antibodies for relapsed follicular lymphoma include epcoritamab (Epkinly, Genmab/AbbVie) and mosunetuzumab (Lunsumio, Genentech). 

Having different options may allow your care to be more personalized.  

Why timing of relapse matters

During the webinar, Dr. Casulo shared that the timing of relapse is important for guiding treatment decisions. Research shows that patients who relapse within two years may have worse outcomes. Those with later relapse often do better. The timing between remission and relapse helps doctors decide how intensive the next treatment should be. 

What’s next in follicular lymphoma treatment?

The latest research in follicular lymphoma is focused on finding more targeted, less toxic treatments. Doctors are studying combinations of therapies. These aim to improve outcomes and reduce side effects. Clinical trials are also testing new options earlier in care. This research is helping expand future treatment choices. 

Discover Follicular Lymphoma Clinical Trials

Living with relapsed follicular lymphoma

Many people live long lives with follicular lymphoma. Some may need several treatments over time. Remissions can become shorter with each treatment. Long-term care often involves monitoring and adjusting treatment when needed. 

Talk to your follicular lymphoma specialist about treatments that are right for you. 

Summary

Relapsed follicular lymphoma can feel overwhelming, but many treatment options exist. Care decisions depend on timing, prior treatments, and overall health. Ongoing research continues to improve care and expand choices for patients.