NCCN Guidelines for Patients® | Follicular Lymphoma Grade 1-2
42 NCCN Guidelines for Patients ® : Follicular Lymphoma, Grade 1–2, 2017 4 Treatment guide Typical type Second-line treatment Guide 9 lists options for second-line treatment and beyond. These options are used if first-treatment didn’t work. They are also used if the lymphoma reappears on tests (relapse). Like first-line treatment, options include chemoimmunotherapy and rituximab alone. Lenalidomide may be received with or without rituximab. There is good proof that ibritumomab tiuxetan works well after first-line treatment. You must meet certain conditions to take this medicine. These conditions include having enough healthy bone marrow. Targeted therapy is an option. Idelalisib may be received if chemotherapy (alkylators) and rituximab don’t work. Copanlisib is a new option. It is an option for follicular lymphoma that has relapsed after 2 other drug regimens. Fludarabine with rituximab and RFND are other options. However, you should be aware that fludarabine-based chemotherapy can prevent you from having a blood stem cell transplant. It can also cause a second cancer over time. The other drug options listed in Guide 9 are used to treat diffuse large B-cell lymphoma. However, they may be helpful for follicular lymphoma, too. These drugs can cause severe side effects. Besides drug treatment, a clinical trial or radiation therapy are options. You may be able to join a clinical trial of a new treatment. 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.