Treatment of follicular follicle centre lymphomas: current status and future perspectives

Follicle centre lymphomas (FCLs) comprise the predominant subtype of indolent nodal lymphomas. Therapy is based on the stage of the disease and consists of extended field or total nodal irradiation in stages I and II. Patients with advanced stages III and IV may initially remain untreated and be watched until the occurrence of disease-related symptoms such as B-symptoms, haematopoietic insufficiency, lymphoma progression or bulky disease. On the occurrence of these signs a cytoreductive chemotherapy of mild to moderate intensity such as cyclophosphamide, vincristine, prednisone (COP) or mitoxantrone, chlorambucil, prednisone (MCP) should be initiated. In responding cases maintenance with interferon-alpha (IFN alpha) leads to a significant prolongation of the progression-free interval. Modifications of this approach include the upfront combination of IFN alpha with anthracycline containing combinations such as cyclophosphamide, doxorubicin, teniposide, prednisone (CHVP). New perspectives arise from the introduction of myelo-ablative radio-chemotherapy with subsequent stem-cell transplantation and antibody-based immunobiological therapies.