follicular lymphoma

Last reviewed 01/2018

• follicular lymphoma is a type of non-Hodgkin's lymphoma:
  
  
  • follicular lymphoma accounts for about 1 in 4 of all cases
    
    
  • a cancer of the B-lymphocytes
    
    
  • can occur any time during adulthood, however more than 70% of follicular lymphomas are diagnosed in people aged over 60 years.
    
    
  • patients with follicular lymphoma typically present with painless, swollen lymph nodes in the neck, armpit or groin. Systemic or 'B' symptoms are rare and include fever, fatigue, night sweats, and unexplained weight loss
    
    
  • equally common in men and women
    
    
  • a low-grade lymphoma and usually develops very slowly
    
    
  • histogical features of this lymphoma:
    • exhibit a follicular or nodular pattern of growth reminiscent of germinal centers - follicular pattern of growth contrasts with diffuse lymphomas, which usually are intermediate or high-grade neoplasms
      • can be classified into four stages of disease (I-IV) that reflect both the number of sites involved and the presence of disease above or below the diaphragm
        
        
  • at most, 10-15% of follicular lymphomas are detected at an early stage; the majority of people present with advanced disease (stage III-IV)
    
    
  • in 2008, the incidence of follicular lymphoma in England and Wales was 3.4 per 100,000 persons, equating to 1900 people
    
    
  • follicular lymphoma is characterised by a relapsing and remitting clinical course over several years, with each successive response to treatment becoming more difficult to achieve and of shorter duration
    
    
  • advanced stage III-IV lymphomas eventually become resistant to chemotherapy and transform to high-grade or aggressive lymphomas, such as diffuse large B-cell lymphoma
    
    
  • in the early 1990s, median survival was expected to be 8-10 years. However, in the past decade, longer median survival has been reported (for example, survival at 20 years has been reported to be as high as 44%)

Reference:

• 1) NICE (January 2012). Rituximab for the first-line treatment of stage III-IV follicular lymphoma