Follicular lymphoma is one type of non-Hodgkin lymphoma (NHL). From a practical viewpoint doctors divide all the various types of NHL into one of three groups: low grade, high grade or intermediate grade. This division is based on the appearances under the microscope and helps predict how the condition will behave.
Low grade NHLs usually have a relatively slow growth rate, running a long course and often needing little or no treatment for months or possibly years. When they do need treatment they respond well but are likely to come back again at some time in the future. They frequently respond to treatment on several occasions over the years but may eventually become resistant or transform to a high grade form of NHL.
High grade types of NHL usually grow more rapidly and behave more aggressively and so need immediate treatment. Despite this they are more likely to be completely cured than low grade NHLs. Around half of all people with high grade forms of NHL will be cured by the use of intensive chemotherapy.
Intermediate types of NHL lie somewhere between these two extremes in their behaviour.
Follicular lymphoma is a low grade lymphoma and often progresses very slowly. If the disease is causing no symptoms it may not be necessary to give treatment immediately. The person would then be seen regularly by their doctor and treatment would be given when significant symptoms or clinical problems arose. It may be some time before this happens.
When treatment is needed, if the follicular lymphoma is confined to just one or two groups of lymph nodes then radiotherapy is usually given. For more widespread disease chemotherapy is used. Follicular lymphoma is very sensitive to chemotherapy and often disappears with simple drug treatment. This is frequently given in tablet form, using a drug called chlorambucil, which may or may not be combined with steroids or with a drug called fludarabine, which is given by injection into a vein. An antibody treatment may also be considered in some situations.
Treatment of early stage follicular lymphoma with radiotherapy may lead to a cure in some people. In people with more advanced disease, treatment with chemotherapy normally leads to a rapid remission, but follicular lymphoma almost always comes back, although it may be years before it reappears. Further chemotherapy can then be given and another remission obtained. This pattern repeats itself over many years.
In some people the disease will become resistant to chemotherapy and in others it may transform to a high grade NHL and then require more intensive treatment.
Although it is still uncertain as to whether it is ever possible to permanently cure follicular lymphoma the great majority of patients can have their disease controlled, and lead a relatively normal life, for a long period of time.