FL often progresses slowly and may not cause any problems for a period of time. Instead, patients will be regularly monitored by their oncologist for months or years until the cancer changes and treatment is considered necessary. This is called ‘watch and wait’ or ‘watchful waiting’.
Full Answer
What are the treatment options for follicular lymphoma?
Another treatment sometimes used for FL is radioimmunotherapy (RIT) using an agent such as yttrium-90 ibritumomab tiuxetan (Zevalin), which is a radioactive particle connected to an antibody that targets cancer cells. To learn about treatments under investigation for FL, download the Follicular Lymphoma Fact Sheet.
What is the treatment strategy for lymphoma?
With this strategy, patients’ overall health and disease are monitored through regular checkup visits and various evaluations, such as laboratory and imaging tests. Active treatment is started if the patient begins to develop lymphoma-related symptoms or there are signs that the disease is progressing based on testing during follow-up visits.
Is'watch and wait'the best treatment for NHL?
"Watch and wait can also be the best approach for some patients diagnosed with widespread NHL that treatment won't likely cure," Abetti says. Even if it's widespread, it may remain stable for years. "Watch and wait doesn't mean being passive," Tsai says.
Should I hold off treatment for non-Hodgkin's lymphoma?
If you have a type of non-Hodgkin's lymphoma (NHL) that grows slowly, don't be surprised if your doctor suggests you hold off treatment. It's an approach called "watch and wait," and it might be a choice for you if you don't have any pain or other symptoms.
How long does watch-and-wait last?
How Long You Can Expect to Watch and Wait. "About half of all patients can put off treatment for at least 3 years," Abetti says. "Some patients can be in watch-and-wait mode for 10 years or more." It's possible you'll never need treatment. There's no way to know for sure if you'll eventually need treatment.
Is watch-and-wait classed as treatment?
Watch and wait means delaying treatment until it is needed. For some people with non-Hodgkin lymphoma, this is an option.
What is the lymphoma protocol?
Most often, the treatment is chemotherapy (chemo), usually with a regimen of 4 drugs known as CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone), plus the monoclonal antibody rituximab (Rituxan). This regimen, known as R-CHOP, is most often given in cycles 3 weeks apart.
How long is treatment for follicular lymphoma?
This four-week period is one cycle of therapy. If this regimen were repeated for a total of six cycles, it would take six months to complete. Novel agents — Most people with follicular lymphoma will relapse multiple times and be treated with many available drugs at some point during their disease course.
What does watchful waiting refer to?
(WACH-ful WAY-ting) Closely watching a patient's condition but not giving treatment unless symptoms appear or change. Watchful waiting is sometimes used in conditions that progress slowly. It is also used when the risks of treatment are greater than the possible benefits.
Can follicular lymphoma go away on its own?
Although follicular lymphoma usually can't be cured, you can live long and well with it. This cancer grows slowly. You may not need treatment for many years, or ever. But if you do, it usually works well.
How many rounds of chemo is normal for lymphoma?
Treatment for many patients is chemotherapy (usually 2 to 4 cycles of the ABVD regimen), followed by radiation to the initial site of the disease (involved site radiation therapy, or ISRT). Another option is chemotherapy alone (usually for 3 to 6 cycles) in selected patients.
How long does it take for Rituxan to work for lymphoma?
Rituximab works by lowering the number of these B-cells, to reduce inflammation, pain, swelling and joint damage. If rituximab works for you, you'll probably notice an improvement in your symptoms 8-16 weeks after you start treatment.
How long does Rituxan stay in your system?
Also, Rituxan may stay in your system 6 to 12 months after your last dose. Because of this, it can be used as a maintenance (long-term) treatment in certain cases. For example, if you have non-Hodgkin's lymphoma (NHL), you'll receive a dose of Rituxan with each chemotherapy treatment, for up to 8 doses.
Can you go into remission with follicular lymphoma?
You can think of follicular lymphoma like a chronic disease. It may come back from time to time, but there are treatments to control it. As more new treatments come out, your chance of having a long-term remission or cure increases.
What is the prognosis for follicular lymphoma?
Outlook / Prognosis Follicular lymphoma is a slow-growing condition that's considered a chronic illness. Studies about half of all people diagnosed with follicular lymphoma are alive nearly 20 years after diagnosis. About 90% of people are alive five years after diagnosis.
What is the latest treatment for follicular lymphoma?
The newest drug to be approved by the FDA for follicular lymphoma is Copiktra (duvelisib), an oral drug that targets PI3K-alpha, a protein that is overexpressed in many B-cell cancers, including follicular lymphoma, and encourages the growth of cancerous cells.
What are monoclonal antibodies?
Monoclonal antibodies can act more directly than chemotherapy agents by targeting particular markers found on B-cells and recruiting immune cells to promote tumor destruction, which can increase response to treatment. Common combination regimens include: 1 R-Bendamustine (rituximab and bendamustine) 2 R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) 3 R-CVP (rituximab, cyclophosphamide, vincristine, and prednisone)
Can you use rituximab alone for FL?
In more advanced stages, physicians may use one or more chemotherapy drugs or the monoclonal antibody rituximab (Rituxan), alone or in combination with other agents.
What percentage of non-Hodgkin lymphoma is FL?
Follicular lymphoma (FL) represents more than 20% of all non-Hodgkin lymphomas worldwide and approximately 30% of the non-Hodgkin lymphomas diagnosed in the United States. Although occasionally localized at the time of diagnosis, most patients have disseminated disease. However, patients are frequently asymptomatic, and this, in combination with a long median survival, led to the initial studies of observing asymptomatic patients without initial therapy, ie, “watch and wait.” Since the initial report of watch and wait as a treatment strategy for patients with low-grade FL, our understanding of the biology of the disease has advanced; multiple active new agents have been introduced into practice, and the survival of patients with low-grade FL has improved. Given these changes, is watch and wait still an acceptable treatment recommendation for a newly diagnosed patient with low-grade FL?
What is a grade 3 lymphoma?
2 It has been recognized for some time that a subset of patients with what is today called grade 3 FL has a more aggressive illness and one that might have durable responses to therapy used for diffuse large B-cell lymphoma. For example, in the Working Formulation, follicular large cell was included in the intermediate-grade lymphomas, not low-grade lymphomas. 3 Grade 3 FL seems to be biologically different based on a higher proliferative rate, 4 a higher median standardized uptake value on positron emission tomography scans (Andrew Zelenetz, Memorial Sloan Kettering Cancer Center, oral communication, March 30, 2016), and different immunological characteristics. 5, 6 Some reports, 7-10 but not all, 11 have found that a subset of these patients has a plateau on their survival curve when treated with anthracycline containing combination chemotherapy regimens.
What is the treatment for FL?
They recommended radiotherapy for patients with limited nonbulky stage I and II. For early-stage patients with high tumor burden, they recommended the same treatment as for patients with stage III and IV.
What is the watch and wait for stage 2 FL?
The National Comprehensive Cancer Network (NCCN) guidelines for the therapy of patients with FL with extensive stage II and stage III/IV include watch and wait as an acceptable initial management approach for patients with low-grade FL who are asymptomatic, have no threatened end-organ function, do not have cytopenias secondary to the lymphoma, or lack bulky disease, and in whom the disease is not steadily progressing. 37 For patients with localized low-grade FL, the NCCN guidelines also include watch and wait as being acceptable management in selected cases in whom the potential toxicity of involved field radiotherapy outweighs the hoped-for clinical benefit.
How long does a low grade FL patient live?
For many years, it appeared that the median survival of patients with low-grade FL was approximately 10 years and that it might not be greatly impacted by therapy. 17-20 However, more recently, numerous reports have suggested a significant improvement in the survival of patients with low-grade FL. 21-23 The survival of patients with low-grade FL treated by physicians in the Nebraska Lymphoma Study Group diagnosed before or after the year 2000, and those who never received rituximab and those who did, suggests that survival is significantly changing and that the availability of rituximab might be an important component in this improvement ( Figure 1 ).
Is watch and wait a reasonable treatment option?
However, until that time, the lack of symptoms, the absence of disease involvement in sites that might be imminently dangerous, and a patient’s desire to avoid therapy as long as possible represent the most practical way to identify those patients for whom watch and wait is a reasonable treatment option.
Is follicular lymphoma a complex disease?
Follicular lymphoma is a more complex illness than previously thought. The survival of patients with low-grade follicular lymphoma is improving. Incidence of transformation to diffuse large B-cell lymphoma.
How long can you wait to get treatment for NHL?
"About half of all patients can put off treatment for at least 3 years," Abetti says. "Some patients can be in watch-and-wait mode for 10 years or more .". It's possible you'll never need treatment.
How often should I have a checkup?
If you choose to delay treatment, your doctor will keep a close eye on you and look for changes. You'll have checkups every 3-6 months, or even more often . The major benefit of watch and wait is that you don't have to deal with treatment side effects, Tsai says.
Can you wait to see a doctor for lymphoma?
Also, if you aren't very good about visiting your doctor, watch and wait may not be a good choice. If you wait too long to set up an appointment, your lymphoma may get worse. Pagination. 1.
Is it hard to accept that you're not actively treating your cancer?
There's a risk that your cancer may change to a fast-growing type. It may also be hard to accept that you're not actively treating your cancer. Tsai says many of his patients struggle with this, but they feel better when they learn that watch and wait is an accepted strategy.
Can you wait to get treatment for non-Hodgkin's lymphoma?
It's an approach called "watch and wait," and it might be a choice for you if you don't have any pain or other symptoms. Your doctor will keep a close eye on your disease, and they won't start treatment ...
Can you wait to see your doctor if you have a slow growing NHL?
Also, if you aren't very good about visiting your doctor, watch and wait may not be a good choice.
Why is FL called follicular lymphoma?
It is called ‘follicular’ lymphoma because the cancerous lymphocytes often collect in lymph nodes in clusters that are known as ‘follicles. FL is the most c’ ommon type of indolent (slow- growing) non-Hodgkin lymphoma, and typically affects middle-aged or older adults.
What is the watch and wait phase?
Once a patient has been treated, the watch and wait phase starts again, as their oncologist will begin to monitor them for a potential return of their cancer. Clinical trials have compared watch and wait with giving chemotherapy treatment immediately.
How long can indolent lymphoma stay stable?
Indolent lymphomas can remain stable for long periods of time, and sometimes regress spontaneously . It has been reported that some patients never require therapy. Treating at diagnosis could result in treating sooner than necessary, sometimes by many years.
What does "watch and wait" mean?
The adage of "watch and wait" has been taken to the extreme to imply a benefit of deferring on therapy for as long as possible . What it actually is meant to indicate is that it is important to wait until you identify who are the progressors from those who are not.
How long does a deferred patient last?
For all 44 "deferred" patients, the median time before requiring treatment was 31 months, and there have been 19 patients who have not yet required therapy for periods of 3 to 104 months. The median actuarial survival for all 44 patients was 121 months.
Can lymphoma cause fatigue?
When you have an indolent (slow growing) lymphoma that is not causing symptoms (such as fatigue) or is not putting you in danger, your doctor might recommend watchful waiting, even when the disease is at an advanced stage.
Is Indolent lymphoma curable?
Indolent lymphomas are often responsive (sensitiv e) to standard treatments, but at this time they are not considered reliably curable * with aggressiv e approaches. So this is another reason to monitor the disease and to treat only when the condition causes symptoms or progresses to a degree that increases risk.
General Treatment Recommendations For FL
General Treatment Algorithm For FL
- Diagnosis of FL involves the following: 1. Perform staging studies and determine FLIPI (Follicular Lymphoma International Prognostic Index) score [3] 2. Assess therapeutic risk-to-benefit ratio for each patient 3. Establish therapy end points (ie, palliation, best response, durable remission, or molecular remission) Stage I/II Treatment options are as follows: 1. Involved-field radiotherapy (I…
Treatment Recommendations For Early-Stage FL
- Stage I or II, World Health Organization (WHO) FL grade 1 or 2[4] Recommendations are as follows: 1. IFRT is the treatment of choice for early-stage disease 2. Radiation doses of 24-30 Gy have been used (36 Gy only if bulky) to involved sites 3. Radiation therapy is preferred for limited-stage FLs; however, if significant toxicity is expected from radiotherapy, initial observation may …
Treatment Recommendations For Advanced-Stage FL
- Stage III-IV or bulky stage II[4] : First-line treatment recommendations are as follows: 1. Rituximab 375 mg/m2 IV weekly for 4 wk with or without four additional doses given every week or every 2 mo (preferred extended schedule of rituximab administration)[5] or 2. Rituximab and fludarabine[6] : Rituximab 375 mg/m2 IV on day 1 plus fludarabine 25 ...
Second-Line and Subsequent Treatments
- Treatment options include the following: 1. Rituximab 375 mg/m 2IV weekly for 4wk 2. Any rituximab chemotherapy regimen described in the first-line treatment setting that was not used before 3. Idelalisib 150 mg PO BID is a phosphoinositide 3-kinase (PI3K) delta inhibitor that has been granted accelerated approval by the US Food and Drug Administration (FDA) (ie, confirmat…