Follicular lymphoma: management options in the era of targeted therapy

For the vast majority of patients diagnosed with follicular lymphoma, the disease is never cured. As a result, it becomes a "chronic disease" that must be managed over many years. A wide array of management options exist, and it is difficult to claim that one strategy is better than another. It remains to be proven that a particular initial therapy or a particular sequence of therapies is superior, if one defines "superior" as affecting survival. It also remains to be proven that immediate treatment is superior to a "watch and wait" approach in patients with low tumor burden. However, newer targeted approaches to treatment are providing additional treatment options, and they generally have more favorable side-effect profiles than traditional cytotoxic therapies. The challenge is determining how to best incorporate such targeted therapies into traditional treatment. Additionally, determining the true impact of newer therapies is not entirely straightforward, as selection bias often confounds trial results in follicular lymphoma. A new follicular lymphoma prognostic index should aid in the interpretation of future clinical trials.