Follicular lymphoma treatment and side effects

Even if you initially go into complete remission (where there's no sign of the lymphoma left) after treatment, the lymphoma will often come back. This is called relapsing.

If you’ve relapsed, your next treatment will depend on:

• how long you've been in remission
• what treatment you have had previously
• what wider options (such as clinical trials) are available.

As a general rule, the longer you've been in remission before you relapse, the better your prognosis (outlook) is likely to be.

Your consultant will usually want to take another biopsy and repeat the staging tests to exclude the possibility of transformation to a high-grade (faster growing) non-Hodgkin lymphoma. This can happen occasionally and it’s important to know if it does.

If the disease comes back soon after your first diagnosis, you’ll have several treatment options.

You may have more chemotherapy. For some people, this will be followed by a stem cell transplant (see below). There’s also a range of targeted treatments which don’t involve chemotherapy and may have fewer side effects.

If the disease comes back later, for example, more than five years after your first diagnosis, your treatment may be very similar to the treatment you’ve already had as it worked well before.

Sometimes, the lymphoma will not respond to your first treatment and you won’t go into remission. This is called refractory disease. If this is the case for you, your healthcare team will suggest a different treatment plan.

These drug combinations have been approved across the UK to treat follicular lymphoma if it relapses (comes back) or doesn't respond to your first treatment (it's refractory):

You’ll usually go to hospital as a day patient to have treatment for relapsed or refractory follicular lymphoma.

• Rituximab and obinutuzumab are drugs called monoclonal antibodies. They are usually given through a drip into a vein, or sometimes rituximab is given as an injection under the skin.
• Chemotherapy drugs such as cyclophosphamide, vincristine and bendamustine are given by injection or a drip (infusion) into a vein or central line.
• Prednisolone is a steroid, taken as tablets.
• Lenalidomide is a targeted therapy drug that you take as capsules.

If you take part in a clinical trial for follicular lymphoma, doctors will typically be testing a new medicine in combination with existing drugs to treat the disease.

There are a number of studies looking at the effectiveness of these trial drugs. If your healthcare team think that these drugs are appropriate for you, they will talk to you about the possibility of joining a trial.

In some cases, a stem cell transplant might be an option for people with relapsed or refractory follicular lymphoma. This may be an autologous stem cell transplant, which uses your own stem cells, or an allogeneic stem cell transplant, which uses cells donated by someone else.

A stem cell transplant isn’t a routine option for all people with follicular lymphoma. They’re usually only recommended for people who have had an early relapse and are medically fit enough to have this type of treatment. This is because stem cell transplants are intensive treatments and have more side effects than other treatment options.

If either type of stem cell transplant is an option for you, your healthcare team will discuss the potential benefits and risks with you before you make a decision.

For more information on stem cell transplants, order or download our booklet Blood stem cell and bone marrow transplants: The seven steps.