The most common indolent lymphoma, follicular lymphoma comprises
35% of adult non-Hodgkin’s lymphoma (NHL) in the United
States and 22% worldwide. Features associated with adverse outcome
include age, male gender, disease stage, and performance status, with
the International Prognostic Index being the most widely used risk classification
system. Long-term disease-free survival is possible in select
patient subgroups after treatment, but very late relapses suggest that
quiescent lymphoma cells might be harbored for long periods of time.
Radiation therapy is the mainstay of treatment for limited-stage follicular
lymphoma, but there is some experience with chemotherapy and
combined chemoradiation. When to initiate treatment in patients with
advanced disease is controversial, but options include various combined
chemotherapy regimens, monoclonal antibodies, radiolabeled antibodies,
and bone marrow or stem cell transplantation. Future directions in
the treatment of follicular lymphoma include vaccines, antisense
therapy, and proteasome inhibitors.