Follicular lymphoma is cancer that starts in your white blood cells. The name “follicular lymphoma” comes from the way abnormal white blood cells develop together in clumps called “follicles” inside the lymph nodes.
This condition is classified as a non-Hodgkin’s lymphoma. This is a broad category with many types of lymphomas. These types of non-Hodgkin’s lymphomas behave and are treated differently than Hodgkin’s lymphoma.
Follicular lymphoma tends to grow slowly. Many people with this type of cancer live for a long time with a high quality of life. Symptoms are often mild or nonexistent when it’s diagnosed.
Read on to learn more about the symptoms of follicular lymphoma and what treatment options are available.
Follicular lymphoma facts and stats
Follicular lymphoma is one of the most common types of lymphoma, and it generally has a good outlook. Here are some key statistics:
- Follicular lymphoma is experienced by about
2.7 out of 100,000 people per year. - Follicular lymphoma is the
most common form of indolent or slow-growing lymphoma. - Follicular lymphoma rarely affects people under age 20. The median age of diagnosis is
63 .
The
- underarms
- neck
- groin
- abdomen
Some people with follicular lymphoma don’t have any symptoms at all.
Other symptoms of follicular lymphoma can include:
- fatigue
- shortness of breath
- fever or night sweats
- unintentional weight loss
- frequent infections
Researchers don’t know exactly why follicular lymphoma develops. It’s likely that a combination of genetic, environmental, and immunologic factors contribute.
Genetic causes of follicular lymphoma
- People with a relative who had follicular lymphoma are at a
slightly increased risk of developing this type of cancer. - About 85 percent of people with follicular lymphoma have a noninherited genetic abnormality called a translocation.
- In adults with this abnormality, parts of chromosomes 14 and 18 break off and switch. This leads to an overexpression of the BCL2 gene.
- The
BCL2 gene is thought to play a role in telling cells when to die. - Some people have the same genetic abnormality but don’t develop follicular lymphoma, which suggests that other factors are also involved.
- More than 25 percent of people with follicular lymphoma have a mutation in their EZH2 gene.
- Children with follicular lymphoma don’t have the BCL2 abnormality. Changes in the MAP2K1 and TNFRSF14 genes have been commonly reported.
Environmental causes of follicular lymphoma
Certain environmental factors may contribute to follicular lymphoma, such as:
- exposure to chemicals like benzene
- exposure to pesticides, such as glyphosates
- some infections may lead to this condition
- smoking and exposure to secondhand smoke
To diagnose follicular lymphoma, your doctor will:
- consider your symptoms
- look at your medical history
- perform a physical exam
If they suspect cancer, they may perform the following tests:
- Lymph node biopsy. A lymph node biopsy involves removing a small portion of tissue from a lymph node, or sometimes an entire lymph node. Medical experts examine the tissue under a microscope to determine if it’s cancerous.
- Blood test. Blood tests can evaluate the number and appearance of your blood cells.
- Imaging. Your doctor may suggest you have an imaging test in order to see the lymphoma in your body and plan your treatment. A CT scan, PET scan, or a PET/CT scan that combines both these methods is commonly used.
Doctors have developed the
- low risk
- intermediate risk
- high risk
Your risk is calculated based on your “prognostic factors,” which consider various factors like your:
- age
- lactate dehydrogenase levels
- hemoglobin levels
- how much the cancer has spread
- cancer stage
Several treatment options are available for people with follicular lymphoma. Your doctor will decide which therapy is right for you based on your type of cancer and how advanced it is.
Watchful waiting
If you’re diagnosed early and have no symptoms or only a few symptoms, your doctor might suggest watchful waiting. This means your healthcare professional will keep a watchful eye on your condition, but you won’t receive any treatment yet.
A 2016 review of studies found that people treated with this strategy have a similar outlook to people who start treatment early.
Radiation
Radiation uses high energy beams to destroy cancer cells. It’s often given to people with stage 1 or 2 follicular lymphoma. In some cases, radiation alone may be able to cure this type of cancer.
You may need radiation along with other therapies if your cancer is more advanced.
Monoclonal antibodies
Monoclonal antibodies are medications that target specific markers on tumors and help your immune cells fight the cancer.
Rituximab (Rituxan) is a monoclonal antibody that’s commonly used to treat follicular lymphoma. It’s typically given as an intravenous (IV) infusion at your doctor’s office, and it’s often used in combination with chemotherapy to treat late stage follicular lymphoma.
Common combinations include:
- r-bendamustine (rituximab and bendamustine)
- R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone)
- R-CVP (rituximab, cyclophosphamide, vincristine, and prednisone)
In 2017, the Food and Drug Administration (FDA) approved the drug obinutuzumab together with chemotherapy for untreated follicular lymphoma stage 2 or higher.
Chemotherapy
Chemotherapy uses drugs to kill cancer cells in your body. It’s sometimes given to people with follicular lymphoma and is frequently combined with other treatments such as monoclonal antibodies or radiation therapy.
Radioimmunotherapy
Radioimmunotherapy involves using a combination of monoclonal antibodies and radiation therapy to destroy cancer.
In 2002, the FDA approved the monoclonal antibody ibritumomab tiuxetan (Zevalin) to treat relapsed or refractory follicular lymphoma. Refractory means the cancer doesn’t respond to treatment or stops responding.
Stem cell transplant
A stem cell transplant is sometimes used for follicular lymphoma, especially if your cancer comes back. This procedure involves infusing healthy stem cells into your body to replace diseased bone marrow. It’s generally only an option for adults in good overall health.
There are two kinds of stem cell transplants:
- Autologous transplant. This procedure uses your own stem cells to treat your cancer.
- Allogeneic transplant. This procedure uses healthy stem cells from a donor. It is not often used for follicular lymphoma.
New CAR T-cell treatments
In 2021, the FDA gave accelerated
CAR T-cell therapy uses engineered molecules called chimeric antigen receptors (CARs) that recognize and destroy antigens on the surface of lymphoma cells.
Follicular lymphoma can turn into a faster-growing form of lymphoma, known as diffuse large B-cell lymphoma. Transformed lymphoma is usually more aggressive and may require more rigorous treatment.
The development of abnormal white blood cells can crowd out healthy blood cells. This can lead to lower levels of various types of blood cells that you need to keep you healthy. For instance:
- A low white blood cell count can weaken your immune system and make you more prone to infections.
- A low platelet count can interfere with your blood’s ability to clot.
- A low red blood cell count can cause symptoms like fatigue, shortness of breath, and weakness.
The buildup of abnormal blood cells can also cause your spleen to enlarge. You’ll likely need to avoid contact sports if your spleen is enlarged to avoid rupture.
Treatments for follicular lymphoma, such as chemotherapy and radiation therapy, can damage healthy cells and cause many side effects, such as:
After successful treatment, many people with follicular lymphoma go into remission. Even though this remission can last for years, follicular lymphoma is considered a lifelong condition.
Recovery can be challenging, but many people are able to maintain a high quality of life. You may feel tired in the months after your treatment, so it’s important to understand that it may take some time before you can regain the same level of activity as before your treatment.
Your doctor can help you understand what to expect and give you advice on how to make your recovery as smooth as possible.
It can be disheartening to learn that your first round of treatment wasn’t successful, but there are other treatment options you can try. Your doctor can work with you to develop a new treatment plan.
Treatments for follicular lymphoma are typically used to keep the disease under control rather than to cure the condition. This cancer can usually be successfully managed for many years, and the average survival rate is more than 20 years.
The 5-year survival rate for people with follicular lymphoma who are low risk (they have only one poor prognostic factor or none) is about 96 percent.
For those with intermediate risk (two poor prognostic factors), the 5-year survival rate is 80 percent. If you’re high risk (three or more poor prognostic factors), the 5-year survival rate is 50 percent.
Survival rates can offer useful information, but they’re only estimations and can’t predict what will happen in your particular situation.
Talk with a doctor about your specific outlook and which treatment plans are right for your situation.
Follicular lymphoma is a slow-growing cancer that starts in the white blood cells inside your lymph nodes.
Many people are able to live a long time with follicular lymphoma, and sometimes the only treatment that’s needed is watchful waiting. People with an advanced stage of this cancer may receive immunotherapy drugs called monoclonal antibodies, often with radiation or chemotherapy.
Follicular lymphoma generally has a good outlook because it tends to grow slowly. It’s likely that the survival rate will continue to rise as treatment options improve.