Follicular lymphoma

The second most common non-Hodgkin's lymphoma is follicular lymphoma. They make up approximately 20-25% of all lymphomas. It is based on B-lymphocytes and thus shows CD 20+ positivity.

Epidemiology
Over the last fifty years, the incidence has increased from 2-3 / 100,000 to the current 7 / 100,000 population.

Clinical manifestations
Follicular lymphoma has similar symptoms to other malignant lymphomas (night sweats, weight loss, subfebrile). It can be asymptomatic for a long time. The clinical course is usually gradual with repeated relapses.

Diagnosis
The diagnosis is made by a pathologist from an excised enlarged node. If the nodes are difficult to access (eg retroperitoneum), it is possible to make a diagnosis based on a biopsy using a thick needle (core biopsy). Aspiration biopsy (FNAB) diagnosis is inappropriate. The pathologist determines the diagnosis based on the presence of tumor centrocytes and centroblasts. Based on the number of tumor centroblasts, three-stage grading is used in follicular lymphoma. It is important that patients who have relapsed be reclassified to lymphoma to rule out transformation into more aggressive lymphoma (eg DLBCL).

Therapy
In patients who have only one node or a strictly localized small lesion, local radiotherapy may be used, which may have curative potential at these stages. There is still no curative therapy in the advanced stages. For patients who do not have severe clinical symptoms, we can use a waiting strategy. A high percentage of remissions can be achieved with the combination of rituximab + CHOP (cyklofosfamid, doxorubicin, vinkristin, prednison), or rituximab + COP (cyklofosfamid, vinkristin, prednison). In patients who have also achieved partial remission, maintenance therapy with rituximab is indicated, which significantly prolongs the asymptomatic period at the time of remission and delays relapse.