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Options for Follicular Lymphoma After First Treatment

Options for Follicular Lymphoma After First Treatment

This article is for patients with relapsed/refractory follicular lymphoma and their care partners, or anyone who wants to learn more about follicular lymphoma. The goal of this patient education activity is help patients engage in shared decision-making with their doctor about treatment options for follicular lymphoma after first (first-line) treatment.

You will learn about:

  • What follicular lymphoma is

  • Goals of treatment for follicular lymphoma

  • Treatment options after first treatment

  • Possible side effects of treatment

  • How treatment may be given

  • Questions to ask your doctor

All medicines listed in this activity may not be approved by the US Food and Drug Administration (FDA) for follicular lymphoma but are recommended by the National Comprehensive Cancer Network (NCCN).

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What Is Follicular Lymphoma?

Lymphoma is a cancer that starts in the lymphocytes, a type of white blood cells. Follicular lymphoma is a type of lymphoma called non-Hodgkin lymphoma.

In follicular lymphoma, normal B cells -- a specific type of lymphocyte -- become cancer cells and grow out of control. They can then travel through vessels in your lymphatic system to your lymph nodes, spleen, and bone marrow.

Cancer cells can also sometimes grow through the lymph nodes and spread to other tissues and organs, such as the bone, skin, digestive system, and lungs. Follicular lymphoma has often spread by the time it's first found, or diagnosed.

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Treatment and Goals

The goals of treatment are to stop or delay follicular lymphoma, prevent or relieve symptoms, and improve your quality of life.

Some people may not need to start treatment right away and may do a "watch-and-wait" option. When treatment is recommended, the first one is called first-line. Depending on which you get and how well it works, your doctor may then recommend maintenance treatment. Maintenance is given to stop or delay cancer from coming back after it's disappeared with first-line treatment.

No one treatment is for everyone, so you and your doctor will make a plan together that fits your goals and needs. Be sure to tell them about your personal preferences for your treatment plan.

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Treating Refractory/Relapsed Follicular Lymphoma

After first-line, a next treatment -- called second-line -- may be recommended if follicular lymphoma is stable or progresses (refractory) or to treat follicular lymphoma that gets worse during follow-up care (relapsed). For some people, a third-line treatment may also be recommended after second-line.

There are several options your doctor may recommend, alone or in combination. Treatment will depend on cancer stage and where it has spread and your previous treatment, test results, and overall health and wishes.

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Treatment Options After First-Line

Treatment that may be used can include:

  • Chemotherapy, or "chemo"

  • Targeted therapy:

    • Kinase inhibitors

    • EZH2 inhibitor

  • Immunotherapy:

    • Antibody treatment

    • Immunomodulators

    • CAR T-cell therapy

    • Radioimmunotherapy

  • Chemoimmunotherapy

  • Steroids

  • Radiation therapy

  • Stem cell transplant  

  • Supportive care to ease symptoms or side effects and improve your quality of life

  • Joining a clinical trial

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How Treatment May Be Given

It's important to take treatment as directed. Do not skip, change, or stop treatment without talking to your doctor first. How long you get treatment for will depend on how your body responds, any side effects, and how your cancer progresses.

Certain treatments are taken by mouth, while others may be given by infusion into a vein (IV). Some can be taken at home, while others are given in a clinic, hospital, or treatment center, sometimes over several visits. With some treatments, you'll be admitted as an inpatient.

With CAR T-cell therapy, your white blood cells are collected during 1 visit, then sent to a lab to make your treatment. Later, you will get your treatment in 1 dose as an IV infusion as an inpatient.

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Possible Side Effects of Treatments Used After First-Line

All treatment can have side effects. Some may be different for different treatments, while others may happen with more than 1 treatment. But the same side effect can mean something different, depending on which treatment you're taking when you have it.

Some common side effects that may happen can include:

  • Fatigue (tiredness)

  • Nausea, vomiting, diarrhea, constipation

  • Loss of appetite

  • Fever, infections

  • Cough, trouble breathing

  • Belly or muscle pain

  • Itching, rash, or skin problems

  • Headache

  • Hair loss

  • Changes in certain lab values

Certain medicines when given by IV infusion can sometimes cause a severe reaction.

Not all side effects are listed here. Ask your doctor for a complete list.

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Managing Side Effects

How side effects are managed will depend on which treatment caused them. Some can go away over time, while others may last longer. Your doctor may recommend adding a medicine before, during, or after treatment to help.

Before you start treatment, ask your doctor about side effects and when you should call them or go to the emergency room because of side effects. Certain treatments may be given in a clinic or hospital to watch for side effects.

Be sure to tell your doctor about any side effects you have, even if they don't seem severe or bothersome. Together, you and your doctor can find ways to manage them.

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Questions to Ask Your Doctor

Questions you can ask your doctor about options for follicular lymphoma after first treatment can include:

  • What treatments are available, and what are treatment goals?

  • What side effects can happen, and how can they be managed?

  • How, where, and for how long will treatment be given?

  • Is there a clinical trial I might be eligible for?

  • How can I have the best quality of life possible?

  • What should I do if I feel stressed or depressed?

  • Where can I find more information and resources?

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You have successfully completed the program Options for Follicular Lymphoma After First Treatment.

View Additional Materials

View Additional Materials on this topic that you may find useful:


Non-Hodgkin Lymphoma

Follicular Lymphoma Overview

Adult Non-Hodgkin Lymphoma Treatment

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Authors and Disclosures

Clinician Reviewer

Karen Badal, MD, MPH

Senior Medical Education Director, Medscape, LLC.

Disclosure: Karen Badal, MD, MPH, has disclosed the following relevant financial relationships:Owns stock, stock options or bonds from: Kallyope, Inc.


Anita A. Galdieri, PharmD, RPh

Associate Medical Education Director, Medscape, LLC.

Disclosure: Anita A. Galdieri, PharmD, RPh, has disclosed no relevant financial relationships.


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