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Updated: Jan 15, 2026
Author Spotlight: Advancing the Detection of Low-Frequency Mutations in Cancer Tissues
Published on: August 23, 2024
Curability Potential of Low-Grade Follicular Lymphoma
F Cabanillas1, J G Conde2, T Gutierrez3
1Centro de Cancer Auxilio Mutuo, San Juan, Puerto Rico; Section of Hematology and Medical Oncology, Department of Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico.
Background:
Classic follicular lymphoma is generally considered incurable. Standard management includes a "watch and wait" strategy for patients with low tumor burden, while those with high tumor burden typically receive chemotherapy.
Objectives:
We aimed to evaluate the potential for curability in a cohort of patients managed with systemic therapy, without the use of a watch-and-wait approach.
Methods:
This study is a retrospective, real-world analysis of patients treated in routine clinical practice. We analyzed 183 previously untreated patients with low-grade follicular lymphoma (LGFL) treated at Auxilio Mutuo Cancer Center in Puerto Rico between June 2002 and July 2023. All patients began therapy shortly after diagnosis, without observation. We stratified treatment based on the presence or absence of "clinically discordant indolent histology" (CDIH), defined by aggressive clinical features such as B symptoms, high lactic dehydrogenase (LDH), SUV >14 on PET, Ki-67 > 30%, or involvement of atypical sites including lung, pleura, soft-tissue, CNS and bones. Patients with CDIH typically received R-CHOP x6 followed by FND (fludarabine, Novantrone [mitoxantrone] and dexamethasone). Non-CDIH patients mostly received FND-R. All patients received 2 years of rituximab maintenance. The primary endpoint was failure-free survival (FFS).
Results:
Among 183 patients, the median follow-up for censored cases was 8.5 years (range: 6 to 261 months). At 10 years, the FFS was 80%; at 15 years, 75%. Of 61 patients followed for more than 10 years, 57 (93%) remain relapse-free, suggesting a potential for cure in those who remain failure-free beyond a decade.
Conclusion:
Our findings support the hypothesis that early initiation of chemotherapy may potentially result in cure for patients with classic follicular NHL. These results warrant confirmation in future prospective studies.
