Clinical practice guidelines for first-line/after-relapse treatment of patients with follicular lymphoma

Key points and recommendations Follicular lymphoma is a subgroup of non-Hodgkin lymphomas of B-cell origin, characterized by a pattern of remissions and continued relapses. It is the second most common type of lymphoid cancer in Western Europe, representing 22-40% of non-Hodgkin lymphomas. The annual incidence of the disease has increased in recent decades. At this time, and with the arrival of new treatment options, patients' outcomes have significantly improved. It is therefore essential to standardize recommendations for the treatment and follow-up of patients with follicular lymphoma, in each clinical scenario. Searches were performed in Medline (PubMed, 1966-present) and The Cochrane Library, using MeSH (Medical Subject Headings) terms whenever possible. The best scientific evidence was obtained from selected randomized studies and meta-analyses. For recommendations where there was no scientific evidence, the consensus of clinical experts was obtained regarding clinical and therapeutic attitudes to improve the treatment of these patients. Recommendations are compiled according to: (i) induction treatment in first-line; (ii) post-induction treatment in first-line; (iii) rescue treatment after relapse; (iv) post-induction treatment in relapse and (v) subsequent treatments. There are different recommendations for each group. They take into account different variables, such as therapeutic options, patient follow-up, laboratory and imaging data, previous response and special groups. The recommendations contained in this guide have been assigned different grades (A, B, C and D), depending on the level of evidence on which they are based (where there is no scientific evidence, they follow the consensus of Good Clinical Practice: see the Appendix). These guidelines provide healthcare professionals with updated and consensual tools for the better management of patients with follicular lymphoma.