Follicular lymphoma: emerging therapeutic strategies

Follicular lymphoma is a diverse disease, both biologically and clinically. Patients may present with indolent, asymptomatic disease or more aggressive, symptomatic disease with high tumor burden. Decision-making to treat in the frontline is based on histology, disease burden and patient symptoms. The general approach should be a combination of rituximab and chemotherapy, traditionally using alkylating agents, with or without an anthracycline, with more recent evidence for the alternative of bendamustine. Relapsed/refractory follicular lymphoma carries similar variability in presentation. Therapeutic options include the same regimens traditionally used for first-line therapy; however, they also include agents, such as bendamustine, bortezomib, lenalidomide and anti-CD20 agents (rituximab, ofatumumab and radioimmunotherapy). Finally, hematopoietic stem cell transplantation (both autologous and allogeneic) remains a useful treatment strategy, although the optimal timing of such approaches requires further clarification.