Is Follicular Lymphoma Deadly?

Follicular lymphoma is a type of non-Hodgkin lymphoma (NHL) that tends to affect older people. This is a slow-growing cancer, and even people with advanced stages have a decent chance of surviving to a relatively normal lifespan.

Follicular lymphoma is a type of non-Hodgkin lymphoma (NHL) that affects B lymphocytes. Lymphomas are cancers of the lymphatic system, which is made up of organs all over the body that make and store white blood cells that fight infection.

Follicular lymphoma is usually a slow-growing (indolent) lymphoma, although some follicular lymphomas can change into a type that grows quickly, and it usually occurs in lymph node sites in the body, as well as in the bone marrow. 

Some patients may have no symptoms of follicular lymphoma when they are diagnosed. 

When symptoms of follicular lymphoma occur, they can include:

• One or more swollen lymph nodes in the neck, groin, underarms, or abdomen
  • They may be felt under the skin, and are usually not painful
• Fatigue/tiredness
• Weakness
• Shortness of breath
• Night sweats that can soak through clothing
• Weight loss
• Fever
• Pain
• Blockages in the digestive tract or urinary tract

The exact cause of follicular lymphoma is unknown. 

Risk factors for developing follicular lymphoma include: 

• Age: average age at diagnosis is 65 years; it is rare in children
• Gender: more likely to be diagnosed in women than men
• Ethnicity: less common among people of Asian or African descent than among people of other ethnicities

Follicular lymphoma is diagnosed with tests such as:

• Blood tests
• Lymph node biopsy
• Bone marrow biopsy
• Computed tomography (CT) scan
• Positron emission tomography (PET) scan

Follicular lymphomas are not usually able to be cured, but may be considered a chronic disease, and patients can live for many years with this form of lymphoma.

Treatment for follicular lymphoma may include one or more of the following: 

• Chemotherapy 
• Radiation therapy 
  • If follicular lymphoma is discovered while it is still in stage 1 (only involves a single lymph node region) it may be able to be cured with radiation therapy
• Monoclonal antibodies 
  • Rituximab (Rituxan) 
  • Obinutuzumab (Gazyva)
  • Yttrium-90 ibritumomab tiuxetan (Zevalin)
    • A radioactive particle connected to an antibody that targets cancer cells used as maintenance therapy
• Bone marrow transplant (also called “stem cell transplant” or “or hematopoietic stem cell transplantation
• Novel agents
  • Newer medications that are not traditional chemotherapy drugs that are often reserved for people with relapsed disease, although some may be used as initial therapy in some cases
    • Lenalidomide (Revlimid)
    • Idelalisib (Zydelig)
    • Copanlisib (Aliqopa)
    • Duvelisib (Copiktra)
    • Tazemetostat (Tazverik)

Follicular lymphoma is usually slow-growing and may be considered a chronic illness, even though it may not be able to be cured. 

The survival rate for follicular lymphoma at five years (that is, the percentage of patients who will be alive 5 years after diagnosis) is 80-90% and median survival is approximately 10-12 years. People with stage I follicular lymphoma may be able to be cured with radiation therapy. For patients who have stage II, III, or IV disease, the average survival is greater than 20 years. Considering median age at diagnosis is 60-65 years, many patients may live a near-normal lifespan. 

The "Follicular Lymphoma International Prognostic Index" (FLIPI) can help predict the prognosis for patients taking into account five factors that affect the outlook for patients, including: 

• Age over 60 years
• Stage III or IV disease 
• Low red blood cell count
• More than four involved lymph node areas 
• Lactate dehydrogenase level higher than normal 

In general, the more of these risk factors a person has, the worse his or her prognosis.