How to Refine Treatment Choice in Follicular Lymphoma: From Low-Tumor Burden to High-Risk Follicular Lymphoma

Follicular lymphoma (FL) is the most common subtype of indolent non-Hodgkin lymphoma in the Western world and has an excellent prognosis with current therapies. Management of FL has traditionally included a watch-and-wait approach or chemotherapy. In the past decade, this treatment paradigm has been challenged with the introduction of the anti-CD20 monoclonal antibody rituximab. In FL, numerous treatment options exist, making therapeutic decision-making challenging. Furthermore, given the disease heterogeneity, there is no standard front-line approach. When making therapeutic decisions in FL, it is crucial for practitioners to assess a number of patient-specific factors including age, disease burden, comorbidities, and coping style. In this review, we examine the various front-line treatment options in FL and outline an algorithm for approaching patients with newly diagnosed FL.