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

40 NCCN Guidelines for Patients ® : Follicular Lymphoma, Grade 1–2, 2017 4 Treatment guide Typical type Clinical trial Joining a clinical trial may be an option. Ask your doctor if there’s a clinical trial that’s right for you. Radiation therapy Radiation therapy is an option for people who are frail and unable to receive drug treatment. Radiation therapy would not cure the cancer. It may shrink the cancer and reduce symptoms. Treatment results Your doctor will assess if treatment is working. Imaging tests are used. Three types of treatment response are used to plan the next steps of your care. These responses are described next. † † Complete remission is the best outcome. Lymph nodes and other organs are back to normal size. Cell metabolism is normal. † † Partial remission is a good response. The size of enlarged lymph nodes or other organs has been greatly reduced. Cell metabolism has slowed down. † † No response or stable disease is less than a partial remission. Enlarged nodes may be smaller but not by much. Cell metabolism is still fast. † † Progressive disease is a worsening of the cancer. Treatment may have induced a complete or partial remission. In this case, options include maintenance or consolidation. Observation may be another option. If there’s no response, a biopsy is advised. Follicular lymphoma sometimes changes into diffuse large B-cell lymphoma. If it has, read the related NCCN Guidelines for Patients ® for chemotherapy options. Rituximab or involved-site radiation therapy may be added to chemotherapy. Other options may include ibritumomab tiuxetan, radiation therapy, a clinical trial, or supportive care only. Maintenance or consolidation Guide 7 lists options for maintenance or consolidation. These treatments may be received if first-line treatment fully or partly treated the lymphoma. Besides active treatment, observation is an option. Rituximab may be used as a maintenance treatment after chemotherapy with rituximab. It is received one time every 8 weeks for 2 years. Rituximab is also used as a consolidation treatment if first-line was rituximab only. It is received one time every 8 weeks for 8 months. Obinutuzumab may be used as a maintenance treatment after chemotherapy with obinutuzumab. It can delay the lymphoma from getting worse. It is received one time every 8 weeks for 2 years. Ibritumomab tiuxetan is another consolidation treatment. It can be received if your first treatment included chemotherapy. You must also have enough healthy bone marrow. Be aware that more research is needed to learn the full impact of having rituximab as your first treatment followed by ibritumomab. Guide 7. Maintenance or consolidation What are options? • Rituximab • Obinutuzumab • Ibritumomab tiuxetan • Observation