How is advanced-stage follicular lymphoma (FL) treated?

Updated: Jan 16, 2019
  • Author: Francisco J Hernandez-Ilizaliturri, MD; Chief Editor: Koyamangalath Krishnan, MD, FRCP, FACP  more...
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Answer

Answer

Stage III-IV or bulky stage II [4] :

First-line treatment recommendations are as follows:

  • Rituximab 375 mg/m2 IV weekly for 4 wk with or without four additional doses given every week or every 2 mo (preferred extended schedule of rituximab administration) [5]  or

  • Rituximab and fludarabine [6] : Rituximab 375 mg/m2 IV on day 1 plus fludarabine 25 mg/m2 IV on days 3-5; repeat every 28 d for six cycles (prophylactic trimethoprim-sulfamethoxazole, acyclovir, and fluconazole necessary) or

  • R-B regimen (rituximab and bendamustine) [7, 8] : Rituximab 375 mg/m2 IV on day 1 plus bendamustine 90 mg/m2 IV on days 1 and 2; repeat every 28 d for six cycles or

  • R-CHOP regimen [9] : Rituximab 375 mg/m2 IV on day 1 pluscyclophosphamide 750 mg/m2 IV on day 1 or 3 plusdoxorubicin 50 mg/m2 IV on day 1 or 3 plusvincristine 1.4 mg/m2 (dose cap at 2 mg) IV on day 1 or 3 plusprednisone 40 mg/m2 PO on days 1-5 or 3-8; every 21 d for six cycles or

  • R-CHOP regimen [10] : CHOP chemotherapy (see above) given at 21-d intervals for six cycles in combination with six doses of rituximab 375 mg/m2 IV administered on day 8 (ie, before CHOP) and day 1 of the first cycle of CHOP, on day 1 of cycles three and five of CHOP, and two additional doses on days 28 and 35 after the last cycle of CHOP or

  • R-CVP regimen [11] : Rituximab 375 mg/m2 IV on day 1 plus cyclophosphamide 750 mg/m2 IV on day 1 plus vincristine 1.4 mg/m2 (dose cap at 2 mg) IV on day 1 plus prednisone 40 mg/m2 PO on days 1-5; every 21 d for six cycles or

  • R-FND regimen (rituximab, fludarabine, mitoxantrone, and dexamethasone) [12] : Rituximab 375 mg/m2 IV on day 1 plus fludarabine 25 mg/m2 IV on days 1-3 plusmitoxantrone 10 mg/m2 IV on day 1 plus dexamethasone 20 mg PO or IV on days 1-5; every 4 wk for eight cycles (prophylactic trimethoprim-sulfamethoxazole, acyclovir, and fluconazole necessary)

After first-line treatment, the following are recommended:

  • Observation
  • Maintenance rituximab [13] : 375 mg/m 2 IV every 8 wk for 2 y

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