Current management of follicular lymphoma

Follicular lymphoma is the most common histological subtype of so-called indolent lymphomas. Despite the high rate of initial response to treatment, these low-grade B-cell non-Hodgkin's lymphomas follow a fluctuating (indolent) clinical course of regression and progression with an overall median survival of 8 to 10 years. Localized disease may be cured by radiotherapy, although in the majority of patients, the disease is already disseminated at the time of presentation. Current therapies include the use of single agents, such as the established drugs chlorambucil or cyclophosphamide, or the newer purine analogues, such as fludarabine. Combination chemotherapy, including the recently developed regimens based on fludarabine, is often advocated in those with more advanced disease or at subsequent recurrences. High-dose myeloablative therapy with autologous support has become a consideration for most patients whom are eligible or suitable for such treatment. Allogeneic transplantation may also be beneficial to a select group. The management of patients with this group of illnesses, however, may be heavily influenced in the future by the emerging immunologically oriented therapies, ie, monoclonal antibodies and idiotype vaccination.