What is follicular lymphoma (FL)?

Follicular lymphoma (FL) is a slow-growing type of non-Hodgkin lymphoma. It develops when B-cells (also called B-lymphocytes) become abnormal. B-cells are white blood cells that fight infection.

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

Symptoms of follicular lymphoma (FL)

Painless swelling in neck, armpit or groin

This is the most common sign of FL. It is caused by lymphoma cells building up in the lymph nodes, which makes them bigger.

B symptoms

Some people also have:

  • drenching night sweats
  • high temperatures (fevers) with no obvious cause
  • unexplained weight loss

Doctors call this group of symptoms B symptoms.

Other symptoms

Sometimes FL spreads to other areas of the body, such as the bone marrow.

This can cause symptoms such as:

  • loss of appetite
  • anaemia - due to low number of red blood cells in your blood
  • bruising or bleeding easily - due to low number of blood-clotting cells (platelets) in your blood.

Causes of follicular lymphoma (FL)

The causes of FL are mostly unknown. Like other cancers, it is not infectious and cannot be passed on to other people. The most common age to be diagnosed with FL is 60 to 65.

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

Diagnosis of follicular lymphoma (FL)

The most common test for this lymphoma is to remove part or all of an enlarged lymph node (a biopsy). This may be done under local or general anaesthetic. The biopsy is then sent to a laboratory to be checked for lymphoma cells. You may also have biopsies taken from other areas of the body.

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.

Staging and grading of follicular lymphoma (FL)

The results of your tests help your doctors find out how many areas of the body are affected by lymphoma and where these areas are. This is called staging.

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

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. This is called a multidisciplinary team (MDT).

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

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

Treatment depends on the stage of the lymphoma and whether you have symptoms that are causing problems. The most common treatments are:

  • Targeted therapy drugs

    The targeted therapy drug rituximab is often used on its own or with chemotherapy to treat FL.

    Other types of targeted therapy are occasionally used to treat FL. One type is called 90Y-ibritumomab tiuxetan (Zevalin®). It is attached to a low dose of a radioactive substance. It carries radiation into the lymphoma cells.

    We have more information on targeted therapies for lymphoma.

  • Chemotherapy

    Chemotherapy is an important treatment for FL and can often get the lymphoma into remission. It is usually given in combination with rituximab. Chemotherapy treatments for FL include the following:

    • R-CVP – this is made up of rituximab, the chemotherapy drugs cyclophosphamide and vincristine, and prednisolone (a steroid). It's given as a drip into a vein, usually once every three weeks.
    • R-CHOP – this is made up of rituximab, the chemotherapy drugs cyclophosphamide, doxorubicin (hydroxydaunomycin) and vincristine (Oncovin®), and prednisolone. These are given as a drip into a vein, usually once every three weeks.
    • R-chlorambucil – this is made up of rituximab and chemotherapy tablets called chlorambucil.
    • R-bendamustine – this is made up of rituximab and the chemotherapy drug bendamustine. This treatment is given as a drip into a vein. This is usually given on 2 consecutive days every 4 weeks.
  • Steroids

    Steroids are drugs that are often given with 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.

  • Stem cell treatment

    A stem cell transplant is an intensive treatment, so it is not suitable for everyone. You may have a transplant using your own stem cells (autologous stem cell transplant) or cells from a donor (allogeneic stem cell transplant).

  • Radiotherapy

    Radiotherapy uses high-energy rays to destroy cancer cells, while doing as little harm as possible to nearby healthy cells. FL is usually very sensitive to radiotherapy.

    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). 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. Radiotherapy is also sometimes given to treat symptoms, such as pain.

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

After follicular lymphoma (FL) treatment

You have regular follow-up appointments after treatment. These appointments are a good opportunity for you to talk to your doctor or nurse about any concerns you have. Your doctor will want to know how you are feeling generally, and to check you are recovering from any side effects of treatment.

Late effects

Sometimes a side effect may continue or develop months or years after treatment. This is called a late effect.

We have more information about long-term and late effects of treatment for lymphoma.

Well-being and recovery

Even if you already have a healthy lifestyle, you may choose to make some positive lifestyle changes after treatment.

Making small changes such as eating well and keeping active can improve your health and wellbeing and help your body recover.

Getting support

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.

The organisations below also offer information and support:

  • Blood Cancer UK
    Blood Cancer UK is a blood cancer research charity that provides information and support on any type of blood cancer.
  • Lymphoma Action 
    Lymphoma Action gives emotional support, advice and information on all aspects of Hodgkin lymphoma and non-Hodgkin lymphoma. It has a national network of people with lymphoma, and local groups.

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