What are the NCCN-recommended chemotherapy regimens for follicular lymphoma?

Updated: Jun 12, 2019
  • Author: Priyank P Patel, MD; Chief Editor: Emmanuel C Besa, MD  more...
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The NCCN lists the following regimens as preferred first-line therapy for follicular lymphoma (FL) [1] :

  • Bendamustine plus obinutuzumab or rituximab
  • CHOP (cyclophosphamide, doxorubicin [hydroxydaunorubicin], vincristine [Oncovin], prednisone) plus obinutuzumab or rituximab
  • CVP (cyclophosphamide, vincristine, prednisone) plus obinutuzumab or rituximab
  • Lenalidomide plus rituximab 

For second-line and subsequent therapy of FL, the NCCN recommends the following as preferred regimens:

  • Bendamustine plus obinutuzumab or rituximab

Other recommended regimens are as follows:

  • Ibritumomab tiuxetan
  • PI3K inhibitors (idelalisib, copanlisib, or duvelisib) – For relapsed/refractory after 2 prior therapies

For elderly or infirm patients who are unlikely to tolerate those regimens, the NCCN recommends the following as first-line, second-line, and subsequent regimens:

  • Rituximab (preferred) (375 mg/m 2 weekly for 4 doses)
  • Chlorambucil plus rituximab
  • Cyclophosphamide plus rituximab
  • Chlorambucil
  • Cyclophosphamide
  • Ibritumomab tiuxetan (category 2B)

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