NCCN Guidelines for Patients® | Follicular Lymphoma Grade 1-2

25 NCCN Guidelines for Patients ® : Follicular Lymphoma, Grade 1–2, 2017 3 Overview of cancer treatments Immunomodulators Rituximab Rituximab is sold as Rituxan ® . It is a liquid that will be slowly injected into your vein (infusion). It often takes a few hours to receive the full dose. How often rituximab is received differs among people. Ask your doctor for more information. Rituximab is also sold as Rituxan Hycela ™ . This medicine is injected under the skin for treatment of certain lymphomas. Injections may be received after the first dose of rituximab by infusion. Also, injections may be an option as long as rituximab isn’t being used with ibritumomab tiuxetan. Injections last between 5 and 7 minutes. You may have an allergic reaction while receiving rituximab. Other common side effects are chills, infections, body aches, tiredness, and low blood cell counts. Rituximab also increases your chances for tumor lysis syndrome, heart problems, and blockage and tears in your gut. Obinutuzumab Obinutuzumab is sold as Gazyva™. Like rituximab, it is injected into a vein. Obinutuzumab is given on some days during six 28-day treatment cycles. You may have an allergic reaction while receiving obinutuzumab. Tumor lysis syndrome, infections, and hepatitis are more likely while taking obinutuzumab. Although not common, you may become confused, dizzy, and have difficulty walking, talking, or seeing. Immunomodulators Immunomodulators are drugs that modify different parts of the immune system. Lenalidomide (Revlimid ® ) is an immunomodulator. It may be received with rituximab as a first-line treatment. It may also be an option if first-line treatment does not work. Lenalidomide treats lymphoma in more than one way. As an immunomodulator, it boosts the immune system. It also helps stop cancer cells from increasing in number. Third, it also works like a type of targeted therapy called an angiogenesis inhibitor. Angiogenesis inhibitors stop the growth of new blood vessels that would provide food (nutrients) to the cancer. Lenalidomide is made in pill form. It is given in cycles of treatment days followed by days of rest. A cycle may consist of 3 weeks of treatment and 1 week of rest. It may also be given for 4 straight weeks. Cycles may repeat until the cancer grows or side effects become severe. Common side effects include low blood counts, diarrhea, itching, rash, and fatigue. Serious but less common side effects include blood clots, bleeding disorders, loss of vision, and skin cancer. Ask your treatment team for a full list of side effects.