Follicular lymphoma: diagnosis and treatment

Abstract

Follicular lymphoma (FL) is a B-cell lymphoproliferative neoplasm of transformed follicular center B cells. FL is characterized by lymphadenopathy, bone marrow involvement, splenomegaly, and less commonly other extranodal sites of involvement. Diagnosis of FL is based on histology of biopsy of a lymph node along with immunohistochemical staining. In typical cases of FL, lymphoma cells show positive expression of surface antigens such as CD19, CD20, CD10 and monoclonal immunoglobulin, as well as cytoplasmic expression of BCL-2 protein. The majority (80–90%) of cases have the characteristic t(14;18) translocation involving the IgH/BCL2-2 genes.

Decision-making to treat in the frontline is based on the algorithms described by the GELF (Group d’Etude des Lymphomes Folliculaires) or BNL (British National Lymphoma) group. The general approach should be immunochemotherapy based on CHOP or CVP regimens, with more recent evidence for the alternative bendamustine. Therapeutic options for relapsed/refractory FL include the same regimens traditionally used for the first-line therapy. Finally, hematopoietic stem cell transplantation (both autologous and allogeneic) remains a useful treatment strategy, although the optimal timing of such approaches requires further clarification.