Management of follicular lymphoma

Despite the fact that a small proportion of patients with follicular lymphoma may be alive 20 years after the initial diagnosis, and that it is repeatedly, albeit usually only partially, responsive to relatively mild therapy, the disease remains stubbornly incurable for the majority. Therefore, the testing of several new therapeutic approaches is welcome. Interferon has been investigated in two settings: in combination with conventional therapy and as "maintenance" following chemotherapy. Prolongation of remission duration has been demonstrated and one study shows a survival advantage. The purine analogue fludarabine, having originally been shown to induce remissions in patients with chronic lymphocytic leukemia, is also effective in follicular lymphoma, although its precise role remains to be determined. Myeloablative therapy with autologous bone marrow transplantation (which has been the subject of much debate and controversy in the context of low-grade lymphoma), has been shown to prolong duration of remission, although presently, there is no survival advantage. Finally, radiolabeled antibody therapy is showing promise in patients in whom other treatment modalities have failed. The significance of "minimal residual disease" manifest as circulating t(14;18)-containing cells, as demonstrated by polymerase chain reaction analysis awaits clarification.