Refining the treatment of follicular lymphoma

Many effective treatments are currently available for patients with follicular lymphoma (FL). However, given the heterogeneity of this disease, identifying the most beneficial treatment for an individual patient remains a challenge, although clinical, genetic and biological features can all potentially be used to refine therapies in individual cases. The Follicular Lymphoma international prognostic index (FLIPI) algorithm is a valuable prognostic tool for risk categorisation. Despite its current limitations, further investigation will help to develop the role of FLIPI in treatment decision-making, and will increase its value in identifying the optimal therapy for individuals. Biological factors such as bulky disease, over-expression of Bcl-2, or histological grade can help to identify patients at high risk of relapse, and distinguish between the benefits of early intervention vs. a watch-and-wait policy in early-stage FL. The tumor microenvironment plays an important role in the development of FL, and identification of biological and genetic markers could help clinicians determine the prognosis of individual patients. Although much work remains to be done, a greater understanding of the biology of FL will lead to the development of novel therapeutic targets and therapies, bringing individualised treatment a step closer.