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

37 NCCN Guidelines for Patients ® : Follicular Lymphoma, Grade 1–2, 2017 Typical type Typical type includes all types other than pediatric type. Treatment options are partly based on cancer stage. Treatment for stages I and II are discussed next. Treatment for stages III and IV are discussed starting on page 39. Stages I & II Guide 4 lists options for first-line treatment of stages I and II. Stage I lymphomas involve one site. The site can be within or outside of the lymphatic system. Stage II lymphomas involve two or more sites that are either above or below your diaphragm. The affected sites in stage II may be next to each other or not. Contiguous sites are next to each other. Non-contiguous sites aren’t next to each other. Treatment for stages I and II is partly based on the nodal size. For follicular lymphoma, bulky disease is a mass larger than 6 cm. Involved-site radiation therapy Involved-site radiation therapy is an option for non-bulky lymphomas. These lymphomas may be observed if radiation may be too harmful. For bulky and non-contiguous lymphomas, radiation therapy may be part of treatment. Immunotherapy ± chemotherapy Options for bulky or non-contiguous lymphomas include rituximab. Chemotherapy may be added. Bendamustine, CHOP, or CVP is often used for chemotherapy. CHOP consists of cyclophosphamide, doxorubicin, vincristine, and prednisone. CVP consists of cyclophosphamide, vincristine, and prednisone. Observation Radiation therapy may be too harmful for some people. Others may refuse radiation. In either case, observation may be an option. Observation or “watch-and-wait” is a period of testing to see if the cancer grows. Treatment may be started once the cancer will cause symptoms or problems. 4 Treatment guide Typical type Guide 4. First-line treatment for stages I & II Stage What are the options? Non-bulky stage I Non-bulky, contiguous stage II • Involved-site radiation therapy Bulky stage I Bulky, contiguous stage II Non-contiguous stage II • Rituximab ± chemotherapy ◦◦ If this treatment doesn’t work well, involved-site radiation therapy may be received • Rituximab ± chemotherapy + involved-site radiation therapy • Observation if radiation therapy would be too harmful