Follicular lymphoma

What is follicular lymphoma?

Follicular lymphoma is the most common sub type of low grade (indolent) lymphoma, making up 20-30% of all non-Hodgkin lymphomas.

Follicular lymphoma is a B-cell lymphoma characterised by tumour cells that appear in a circular, or clump-like, pattern under the microscope. These irregular shaped follicles replace the normal structure of a lymph node. Over 90% of people with follicular lymphoma have a protein called CD20 on the surface of the cancerous follicular cells. This protein is a target for some kinds of treatment.

How does follicular lymphoma affect the body?

Follicular lymphoma tends to behave like a chronic condition with people experiencing long periods of relatively good health. It tends to grow slowly in most cases and by the time symptoms develop, 80%-85% of people are diagnosed with stage 3 or 4 follicular lymphoma. The most common first sign of follicular lymphoma is a painless swelling in the lymph nodes of the neck, armpit or groin. Other symptoms may include loss of appetite and tiredness, shortness of breath and generalised unexplained aches and pains. At the time of diagnosis, most people usually have tumours in many parts of the body and follicular lymphoma can sometimes transform into a more aggressive form of non-Hodgkin lymphoma, usually diffuse large B-cell lymphoma. Occasionally follicular lymphoma can occur outside of the lymph nodes (e.g. the skin), and this is called extranodal follicular lymphoma.

Who does follicular lymphoma commonly affect?

Follicular lymphoma typically affects people aged over 50, with the average age at diagnosis being 60 years. Most people with follicular lymphoma are aged over 65 and it is slightly more common in men than in women.

What causes follicular lymphoma?

The causes of follicular lymphoma are unknown. It is not due to infection and is not contagious.

How is follicular lymphoma treated?

Treatment for follicular lymphoma depends on the individual situation.  If it is localised to one area, local radiotherapy may be given.  When follicular lymphoma is at an early stage and/or the person is symptom-free, the ‘watch and wait’ approach is usually taken which involves close monitoring by the specialist, with active treatments such as chemotherapy being deferred. Once symptoms develop or if the follicular lymphoma is progressing, radiation therapy or chemotherapy is used to treat the disease. Chemotherapy may be a single agent in combination with a targeted therapy, or combination chemotherapy. The targeted therapy is occasionally used on its own, but mostly in combination with chemotherapy. Radioimmunotherapy such as radiolabelled targeted therapy may also be used. Some people with advanced follicular lymphoma may eventually have a stem cell transplant using either their own stem cells (autologous) or stem cells from a donor (allogeneic).