If the lymphoma is only in one or two groups of lymph nodes in the same area of the body, you may be offered radiotherapy.
If the lymphoma is more widespread and not causing symptoms, you may not need to have treatment immediately. Early treatment at this stage doesn’t help people to live longer and can cause side effects.
You'll be seen regularly by your cancer specialist or GP, and treatment will be advised when you start to get symptoms. It may be some time before this happens and some people may never need any treatment.
After treatment, many people have a period of time with no signs of active disease, which is known as remission. If the lymphoma comes back, it can be treated again. This can give another period of remission, and follicular lymphoma can often be controlled in this way for many years.
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It is an important treatment for follicular lymphoma and can often get the lymphoma into remission.
Chemotherapy is often given in combination with a drug called rituximab (Mabthera ®), which is a monoclonal antibody.
Chemotherapy can be given as tablets or into a vein (intravenously). You may be given just one type of chemotherapy drug or you may be given two or more chemotherapy drugs together (combination chemotherapy).
Chemotherapy treatments for follicular lymphoma include:
R-CVP is made up of the monoclonal antibody rituximab, the chemotherapy drugs cyclophosphamide and vincristine, and the steroid prednisolone. It's given as a drip into a vein, usually once every three weeks.
Chlorambucil is another commonly used treatment. It comes as tablets and is usually given on its own.
R-CHOP, which is a combination chemotherapy treatment, is sometimes given. This includes the chemotherapy drugs vincristine, cyclophosphamide and doxorubicin, as well as prednisolone (a steroid) and a monoclonal antibody called rituximab.
Fludarabine can be given as tablets or into a vein, and may be given on its own or with other chemotherapy drugs.
Bendamustine is given as a drip into a vein.
There are other chemotherapy drugs and combinations that can be used to treat follicular lymphoma. Your specialist will be able to tell you which is most appropriate for you.
Monoclonal antibody therapy
Monoclonal antibodies are drugs that recognise, target and stick to specific proteins on the surface of cancer cells, and can stimulate the body’s immune system to destroy these cells.
Rituximab (Mabthera ®)
Rituximab is a monoclonal antibody, which is commonly used to treat follicular lymphoma. It is often given with chemotherapy as part of a regime called R-CVP or sometimes R-CHOP.
Some people who have no signs of lymphoma at the end of their treatment (remission) may be given additional treatment to help keep the lymphoma in remission. This involves treatment with rituximab for up to two years and is known as maintenance therapy.
Other monolonal antibodies
Other types of monoclonal antibodies are occasionally used. One type, called 90Y-ibritumomab tiuxetan (Zevalin ®), is attached to a low dose of a radioactive substance, and delivers radiation into the lymphoma cells.
Steroids are drugs that are often given with chemotherapy to help treat lymphomas. They also help you feel better and can reduce feelings of sickness (nausea).
Stem cell treatment (transplants)
Some people with lymphoma may have treatments involving the use of their own stem cells or stem cells from a donor. Stem cells are a special type of blood cell that can make all other types of blood cells.
This treatment is not suitable for everyone and isn't done routinely. It is sometimes used to treat follicular lymphoma that has come back after treatment (relapsed). Doctors take into account a person's general health and fitness before recommending stem cell transplants.
Some people have some of their own stem cells collected and stored. This allows them to have higher doses of chemotherapy to destroy the lymphoma cells.
After the chemotherapy, their stem cells are returned by a drip (like a blood transfusion) to help their blood cells recover from the effects of chemotherapy. This is called high-dose treatment with stem cell support.
Some people may have treatment using stem cells from another person (a donor). This is called an allogeneic transplant.
Radiotherapy is the use of high-energy rays to destroy cancer cells while causing as little harm as possible to the healthy cells. Follicular lymphoma is usually very sensitive to radiotherapy.
It may be used as a first treatment if the lymphoma cells are contained in one or two groups of lymph nodes in the same part of the body (stage 1 or 2). In some people this may cure the lymphoma.
Radiotherapy can also be used to treat lymphoma that has come back in one area of lymph nodes.