follicular lymphoma

Follicular lymphoma

Follicular lymphoma is B lymphocyte lymphoma. The word "follicular" refers to the way lymphoma cells cluster in a lymph node or other tissues.

Follicular lymphoma is the second most common type of non-Hodgkin's lymphoma (NHL). It usually appears in adults 50 years of age or older, and the average age in diagnosis is 59 years. It affects a little more the woman than the man.

In most cases, follicular lymphoma is diagnosed at stage 3 or 4. It often spreads to the bone marrow and spleen, but it usually does not affect other organs and tissues than the lymph nodes.

Follicular lymphoma is sometimes transformed into large B-cell (LDGCB) diffuse lymphoma. The LDGCB is a rapidly evolving (aggressive) NHL type.

Symptoms
It is possible that follicular lymphoma does not cause symptoms. Sometimes the lymph nodes of different parts of the body are larger than normal.

Prognostic factors
The care team uses the Follicular Lymphoma International Prognostic Index (FLIPI) to help assess people with this disease and plan for treatment. People with favorable prognostic factors should respond well to treatment. The risk of reappearance (recurrence) of follicular lymphoma after treatment is higher when a person has adverse prognostic factors.


The care team assigns 1 point for each adverse prognostic factor. She then sums them up to get a score of 0 to 5. People whose prognostic factors are favorable and whose score is low have a better prognosis than people who have 3 or more adverse prognostic factors and whose score is high.

Treatments
There are many treatment options for follicular lymphoma. This type of NHL reappears (re-offends) often after being treated, but usually reacts to another series of treatments. The person often comes back to the remission after being treated again, but the remissions are usually more and more short with each series of treatments.

Radiotherapy
External radiation therapy is used to treat ganglion regions affected by stage 1 or 2 follicular lymphoma. We can then talk about radiation from the field reached.

Follicular lymphoma is usually more advanced (stage 3 or 4) and has generally spread to more than one ganglion region when diagnosed. Low-dose external radiation can be administered to help relieve symptoms when follicular lymphoma is more advanced.

Vigilant Observation
Vigilant observation, also known as active surveillance, can be proposed for follicular lymphoma as it develops slowly and may not need to be treated immediately. The care team carefully monitors the person with follicular lymphoma and begins treatment when symptoms appear or if there are signs that the disease is evolving more quickly.

Chemotherapy
Chemotherapy can be proposed to treat follicular lymphoma, especially if it has spread to several groups of lymph nodes or other organs and if it causes symptoms. One can administer a single chemotherapeutic agent or associate a few.

Chemotherapy is often associated with a targeted drug.

You can use only one of these medications:

Fludarabine (Fludara)
Bendamustine (Treanda)
Chlorambucil (Leukeran)
These drug associations can be administered:

CHOP – Cyclophosphamide (Cytoxan, Procytox), doxorubicin (Adriamycin), vincristine (Oncovin), and prednisone
R-Chop – Chop with rituximab (Rituxan)
CVP – cyclophosphamide, vincristine and prednisone
R-CVP – CVP with rituximab
FND – Fludarabine, Mitoxantrone (Novantrone) and dexamethasone (Decadron, Dexasone)
BR – Bendamustine and rituximab
Targeted treatment
Targeted treatment uses drugs to target specific molecules (such as proteins) located on the surface of cancer cells. These molecules contribute to the sending of signals that tell cells to grow or divide. By targeting these molecules, medications interrupt the growth and spread of cancer cells while limiting damage to normal cells.

Rituximab is a targeted drug that is administered to treat follicular lymphoma. It can be administered alone or associated with chemotherapy. It can also be used as a maintenance treatment after chemotherapy.

There are other targeted medications that can be used when follicular lymphoma reappears after being treated (relapse) or when it is no longer responsive to treatment, i.e. the disease is refractory:

Ibritumomab (Zevalin)
Idélalisib (Zydelig)
Obinutuzumab (Gazyva) with Bendamustine
Ibritumomab is a type of radioimmunotherapy, which sets a radioactive material to the targeted drug. The targeted drug is attached to the lymphoma cells, causing the radiation to be administered directly to these cells, which may mean fewer side effects or less severe side effects.

Stem cell transplant
Stem cell transplantation may be an option for some people if follicular lymphoma reappears after treatment (recurrence) or does not respond to treatment (refractory disease).