What is follicular lymphoma (FL)?

Follicular lymphoma (FL) is a type of non-Hodgkin lymphoma. FL develops when B cells become abnormal (cancerous). B-cells are white blood cells that normally help fight infection. They are sometimes called B-lymphocytes.

The abnormal B-cells (lymphoma cells) usually build up in lymph nodes, but they can affect other parts of the body.

Follicular lymphoma develops slowly. You may not need treatment straightaway.

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For healthcare professionals

If you are a healthcare professional, use our guide to find the right information and support for your patients affected by lymphoma. This explains the support available from Macmillan and from other trusted organisations.

Symptoms of follicular lymphoma (FL)

Painless swelling in the neck, armpit or groin

Painless swelling in the neck, armpit or groin is the most common symptom of FL. It is caused by lymphoma cells building up in the lymph nodes, which makes them bigger.

B symptoms

Some people also have symptoms that doctors call B symptoms. These can include:

drenching night sweats which require a change of nightwear and bed covers
high temperatures (fevers) with no obvious cause
unexplained weight loss.

Knowing if you have any B symptoms will help your doctor to stage the lymphoma and plan your treatment.

Other symptoms

Sometimes FL can affect other areas of the body, such as the bone marrow.

This can cause symptoms such as:

anaemia - this is caused by the low number of red blood cells in your blood
bruising or bleeding easily - this is caused by the low number of blood-clotting cells (platelets) in your blood.

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Causes of follicular lymphoma (FL)

The causes of follicular lymphoma (FL) are mostly unknown. Having a close relative (parent, brother or sister) with FL may slightly increase your risk of developing it. We do not know why this is.

Like other cancers, FL is not infectious. It cannot be passed on to other people.

We have more information about causes and risk factors in our information about non-Hodgkin lymphoma.

Diagnosis of follicular lymphoma (FL)

The most common test for diagnosing lymphoma is a biopsy. This may be done under local or general anaesthetic. A doctor will take a sample of tissue from the affected area. The most common place to take a biopsy from is an enlarged lymph node. This is called a lymph node biopsy. You may have all or a part of the lymph node removed. The tissue will be sent to a laboratory for testing. You may also have biopsies taken from other areas of your body, such as your bone marrow.

You can read more about further tests you may have in our information about non-Hodgkin lymphoma.

Waiting for test results can be a difficult time. It may help to talk to your family, friends or specialist nurse.

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Booklets and resources

Staging and grade of follicular lymphoma (FL)

Your test results will help your doctors find out how many areas of your body are affected by lymphoma and where these areas are. This is called staging.

Lymphomas are also grouped as either low-grade or high-grade. Low-grade lymphomas are usually slow growing. High-grade lymphomas usually grow more quickly. Follicular lymphoma (FL) is a low-grade lymphoma and normally develops slowly. Sometimes it can change (transform) to a high-grade lymphoma.

Knowing the stage and grade of the lymphoma helps your doctor plan the right treatment for you.

We have more information about staging and grading of non-Hodgkin lymphoma.

Treatment for follicular lymphoma (FL)

A team of specialists will meet to discuss the best possible treatment for you. They are called a multidisciplinary team (MDT).

Your doctor, cancer specialist or nurse will explain the different treatments and their side effects to you. They will also talk to you about things to consider when making treatment decisions.

Treatment for follicular lymphoma (FL) depends on the stage of the lymphoma and whether you have symptoms that are causing problems. FL can often be kept under control with treatment.

You may have some treatments as part of a clinical trial.

Watch and wait

FL usually develops slowly. Some people may not need treatment for months or years. During this time, they have regular check-ups to monitor the lymphoma. This is called watch and wait.

First line treatment

The first treatments you have are called first line treatment. The aim of treatment is to control the lymphoma for as long as possible. This is called remission.

These are the most common treatments for FL.

Immunotherapy and chemotherapy
FL is often treated with an immunotherapy drug given on its own or in combination with chemotherapy (chemoimmunotherapy). The main immunotherapy drugs used are:

rituximab

obinutuzumab

The most common combinations of chemotherapy are:

CVP – called R-CVP (with rituximab) or O-CVP (with obintuzumab)

CHOP – called R-CHOP (with rituximab) or O-CHOP (with obintuzumab)

Sometimes the single chemotherapy drug bendamustine is used with an immunotherapy drug, instead of a combination chemotherapy. Other chemotherapy treatments may also sometimes be used.
Steroids

Steroids are drugs that are sometimes given with CVP or CHOP chemotherapy to help treat lymphomas. They also help you feel better and can make you feel less sick. Prednisolone tablets are the most commonly used steroid to treat FL.
Radiotherapy

Radiotherapy uses high-energy rays to destroy cancer cells, while doing as little harm as possible to nearby healthy cells. It may be used as a first treatment if the lymphoma cells are contained in 1 or 2 groups of lymph nodes in the same part of the body (stage 1 or 2). FL is usually very sensitive to radiotherapy.

Radiotherapy can also be used to treat lymphoma that has come back in one area of lymph nodes. Radiotherapy is also sometimes given to treat symptoms, such as pain.

Maintenance treatment

If the lymphoma is in remission after the first line treatment, you are usually offered further treatment to help stop it coming back. This is called maintenance treatment. You will be given rituximab or obinutuzumab, usually once every 2 months for up to 2 years.

If the lymphoma comes back

FL often comes back. This is called recurrence or relapse. If this happens you can usually have more treatment to help control it again. It may be possible to get the lymphoma into a second remission. You may then be able to have more maintenance treatment.

Treatments that can be used include:

the same combination of chemoimmunotherapy you had the first time – if you had a long remission
a different combination of chemoimmunotherapy
an immunotherapy drug on its own
a targeted therapy, such as lenalidomide or idelalisib
intensive treatment and a stem cell transplant.

Your doctor will discuss the best options for your situation. We have more information about treating lymphoma that has come back.

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After treatment for follicular lymphoma (FL)

People often have many different feelings when they finish lymphoma treatment. You may feel relieved that treatment has finished, but worried about what will happen in the future.

You will have appointments with your lymphoma doctor or nurse less often than before. But at the same time, you may have new challenges to cope with and things to think about.

We have information below about some of the things people ask about after lymphoma treatment. But you may have other questions or need information about something else. If there is something you want to talk about at any point after treatment, you can:

call the Macmillan Support Line free on 0808 808 00 00
chat to our specialists online
visit our Online Community to talk to people who have been affected by lymphoma, share your experience, and ask an expert your questions.

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After treatment

Lymphoma follow-up

You will have regular follow-up appointments after your treatment. You can talk to your doctor or nurse about any concerns you have at these appointments. Your doctor will want to know how you are feeling, and to check you are recovering from any side effects of treatment.

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Follow-up after lymphoma treatment

Side effects of lymphoma treatment

You may have some ongoing side effects as you recover from lymphoma treatment. You can use our impacts of cancer A-Z to search for information about managing different symptoms and side effects. Or find out more about side effects of treatment for Hodgkin lymphoma or treatment for non-Hodgkin lymphoma.

Tiredness and fatigue

Tiredness (fatigue) often affects people with cancer. It can be caused by lymphoma or be a side effect of lymphoma treatment. RESTORE is an online resource that aims to help people living with cancer related fatigue.
Sexual well-being

Lymphoma and its treatment can sometimes affect your sex life. There are ways to improve your sexual well-being and to manage any problems.
Fertility
Treatment for lymphoma may affect your fertility. If you are worried about your fertility it is important to talk with your doctor before you start treatment. We have more information about:

fertility after treatment for women

fertility after treatment for men.

Sometimes side effects may continue or develop months or years after treatment. These are called late effects. We have more information about long-term and late effects of treatment for lymphoma.

Well-being and recovery

It can take time to recover after lymphoma treatment. Some days you may feel better than others.

It is important to know where to get support or information if you need it. People often need support even some time after lymphoma treatment. But sometimes it is difficult to know who to ask for help. To find support:

ask your GP or someone from your cancer team for advice about support in your area
search cancercaremap.org to find cancer support services near you
call us free on 0808 808 0000 or talk to us online - our cancer information and support specialists can offer guidance and help you find what you need.

Our course Help to Overcome Problems Effectively (HOPE) helps people during and after cancer treatment. It is a free, interactive, group based, self management support course. It runs for 6 weeks, with each weekly session lasting 2.5 hours. To find out more about HOPE courses in your area, email ServiceOpsSupport@macmillan.org.uk

A healthy lifestyle can help speed up your recovery. Even small lifestyle changes may improve your well-being and long-term health.

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Being physically active after treatment

Booklets and resources

Support for people with follicular lymphoma

We understand that being diagnosed with cancer can affect you both physically and emotionally. We have information and advice to help you.

Talk to someone about follicular lymphoma

Everyone has their own way of dealing with illness and the different emotions they experience. You may find it helpful to talk things over with family and friends or your doctor or nurse.

Macmillan can offer emotional, practical and financial help and support. If you would like to talk, you can:

Call the Macmillan Support Line on 0808 808 00 00.
Chat to our specialists online.
Visit our follicular lymphoma forum to talk with people who have been affected by follicular lymphoma, share your experience, and ask an expert your questions.

More information and advice

We know cancer can affect you physically, emotionally and financially. We have information and advice about different ways cancer might impact you, such as help with:

Booklets and resources

Other organisations who offer information and support

The organisations below also offer information and support:

Blood Cancer UK

Blood Cancer UK offers support and information to people affected by blood cancers, including lymphoma.
Lymphoma Action

Lymphoma Action provides high quality information and support for people affected by lymphoma. It provides helpline services and a range of peer support including online support meetings, educational events and webinars. Its website includes TrialsLink, a database of lymphoma clinical trials.

Supporting someone with lymphoma

When someone you know is diagnosed with lymphoma, it can be difficult to know how to support them. You may want information to help you understand what they are going through. Or you may be worried about what to say.

We have information to help with the practical, emotional and financial impacts of supporting someone. You can also talk to us by:

calling the Macmillan Support Line
using chat online
visiting our family and friends forum to talk with people who are supporting someone with cancer, share your experience, and ask an expert your questions.

Booklets and resources

Access our lymphoma information in other formats

We are working to make our website as accessible as possible. We want everyone to be able to use it to find the information they need. We have tips about using settings on your computer or device to help you use our website in our accessibility statement.

We also provide information in a range of languages and formats. If you cannot find the information you are looking for in the format or language you need, email us at cancerinformationteam@macmillan.org.uk

Order our non-Hodgkin lymphoma booklet

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Find our non-Hodgkin lymphoma booklet ebook and pdf

If you prefer a pdf, ePub or Mobi version, our Understanding non-Hodgkin lymphoma booklet is available in these formats.

Booklets and resources

Listen to our lymphoma audiobook

You can listen to our Understanding non-Hodgkin lymphoma audiobook. You can also search our full range of audiobooks.

Booklets and resources

Find non-Hodgkin lymphoma information in your language

We have a range of translated cancer information. This includes information about different cancer types, being diagnosed, cancer treatment, and side effects. We have some lymphoma information in the following languages. You can also search our most up to date list of web pages we have translated on request.

Bulgarian - Mantle cell lymphoma / Мантелноклетъчен лимфом [PDF]
German - Follicular lymphoma / Follikuläres Lymphom (FL) [PDF]
Polish - Diffuse large B-cell lymphoma (DLBCL) / Chłoniak rozlany z dużych komórek B [PDF]
Polish - Lymphoma / Chłoniak [PDF]
Slovak - Anaplastic large cell lymphoma (ALCL) / Anaplastický veľkobunkový lymfóm [PDF]
Slovak - Follicular lymphoma / Folikulový lymfóm [PDF]
Tamil - Follicular lymphoma [PDF]

If you would like any of our lymphoma information translated into your language, please email cancerinformationteam@macmillan.org.uk

Watch British sign language videos

You can watch our BSL videos about cancer on YouTube.

Find our easy read booklets

Our easy read booklets use simple words and pictures to tell you about cancer. They can be useful if you want information that is easier to understand.

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About our information

References

Below is a sample of the sources used in our follicular lymphoma (FL) information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

Armitage JO and Longo DL. Is watch and wait still acceptable for patients with low-grade follicular lymphoma? Blood. 2016. 127:23:2804-2808. Available from: www.ashpublications.org/blood/article/127/23/2804/35265/Is-watch-and-wait-still-acceptable-for-patients

Dreyling M, Ghielmini M, et al on behalf of the ESMO Guidelines Working Group. Newly diagnosed and relapsed follicular lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 2014. 25 (Supplement 3), iii76–iii82. Available from: www.annalsofoncology.org/action/showPdf?pii=S0923-7534%2819%2934083-9

Reviewers

This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Anne Parker, Consultant Haematologist.

Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.