Before you learn about the treatment of follicular lymphoma, understand how it is diagnosed.
Click here to learn about follicular lymphoma diagnosis >>

How is Follicular Lymphoma Treated?

Key takeaways:

  • Doctors recommend cancer treatment regimens based on specific factors of the disease, but individual clinicalClinical
    Having to do with the examination and treatment of patients.
    and lifestyle goals also play a role in determining the ideal treatment strategy
  • There are many options for treating follicular lymphoma, including chemotherapy, radiation, immunotherapy, and combination regimens, but watchful waiting can also be a viable option for patients exhibiting little or no lymphoma symptoms
  • The success of a patient’s cancer treatment regimen is measured by levels of response, which are defined by the change in amount of abnormal cells as a result of treatment

Choosing a Treatment That's Right For You

Although the medical community has made great leaps forward in understanding follicular lymphoma, it is not yet considered curable.1 Fortunately, patients with follicular lymphoma have more cancer treatment options today than ever before.

Because follicular lymphoma is different for each person, choosing an individualized cancer treatment strategy can be complicated.2

What factors affect treatment choice?1,3

When choosing among treatments, doctors will first take into account specific factors about your disease such as:

Be sure to choose a treatment that’s right for you based on your disease, goals, and preferences.

What other goals should I consider when discussing follicular lymphoma treatment with my doctor?

In addition to disease factors, individual goals and treatment preferences for each unique patient should also play a role in defining the cancer treatment approach.

Some clinicalClinical
Having to do with the examination and treatment of patients.
goals and factors your doctor may consider include:

Some treatment preferences include:

  • Forgoing chemotherapy at your first or second relapse
  • Short treatment regimens

What are common follicular lymphoma treatments?

After you are initially diagnosed, you will be presented with options to determine first-line treatment.

After evaluating your disease factors, personal situation, and goals, the doctor may recommend these types of cancer treatments:

Watchful Waiting
  • Watchful waiting1
    • Patients do not receive any treatments, but their health and disease are monitored through regular checkup visits and follow-up evaluation procedures
    • These patients continue to remain untreated as long as they do not have any symptoms and there is no evidence that the lymphoma is growing or spreading
    • Recommended for patients with little or no lymphoma symptoms because the risks associated with intervention outweigh potential benefits
Radiation
  • Radiation2,3
    • Recommended for stage I or II patients
    • This therapy uses ionized radiation to destroy cancerous cells, but can also harm healthy cells
    • Radiation generally has a high response rate for follicular lymphoma
    • Radiation can provide a cure in some patients with limited disease
Chemotherapy
  • Chemotherapy2
    • This therapy uses drugs (individually or in combination) to kill or control cancerous cells, but it can also harm healthy cells
    • Chemicals are usually injected into the bloodstream or taken orally
    • The regimen is delivered in cycles of treatment and rest periods to allow the body time to recover. Typical chemotherapy regimens for follicular lymphoma are delivered in 6 to 8 cycles with each cycle lasting 3 to 4 weeks.
    • Chemotherapy generally has a high response rate for follicular lymphoma
    • Common combination chemotherapy regimens:
      • R-CVP (rituximab, cyclophosphamide, vincristine, prednisone)
      • R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone)
      • R-Bendamustine (rituximab, Treanda)
Immunotherapy
Radioimmunotherapy
Targeted Therapy
  • Targeted therapy3
    • This therapy uses specifically targeted drugs to inhibit changes in normal and cancer cells

How is success of follicular lymphoma treatment measured?

The overall goal of cancer treatment is to eliminate the presence of lymphoma cells in the body. So how is progress determined?

After you have completed and recovered from cancer treatment, you will undergo a follow-up examination to measure your response to treatment.

You may hear many different terms for the criteria for cancer treatment response. Here's how some common terms are defined:4

Complete Response (CR)
  • Complete Response (CR)
    • This is the best-case scenario
    • The disease has completely disappeared after cancer treatment, but future relapse is still possible
    • Complete response means no trace of cancer is found in lab tests, scans, or during physical examination
Partial Response (PR)
  • Partial Response (PR)
    • The disease has reduced since cancer treatment, but some still remains–with at least a 50% reduction in number or size of masses with no new sites of disease
Progression-Free Survival (PFS)
  • Progression-free Survival (PFS)
    • The length of time during and after the treatment that a patient lives with the disease, but the disease does not get worse

Remember, there is no cure for follicular lymphoma. A successful course of therapy does not mean that your cancer is gone—it’s important to be prepared for relapse.1

Anticipating follicular lymphoma relapse

In most cases, following a period of remission, follicular lymphoma will come back, or “relapse.” A person may experience multiple relapses, and these relapses can occur years apart.1

Anticipating follicular lymphoma relapse

Since your follicular lymphoma is likely to relapse, you should always plan for what’s next by evaluating your future treatment options and determining what will make the most sense for you when the disease progresses.

ZEVALIN is an option if your follicular lymphoma relapses
or is refractoryRefractory
In medicine, describes a disease or condition that does not respond to treatment.
5

ZEVALIN is a treatment for follicular lymphoma that combines two effective therapies in a single course of treatment—immunotherapy and radiotherapy.

ZEVALIN treatment is chemo-free for relapsed patients and is a short-course therapy–the entire treatment regimen can be completed in less than 10 days.

Learn more about whether ZEVALIN is right for you and important safety information about ZEVALIN>>

Indications and Usage

ZEVALIN® (ibritumomab tiuxetan) injection for intravenous use is a prescription medication that has three parts: two infusions of rituximab and one injection of Yttrium-90 (Y-90) ZEVALIN. Rituximab is used to reduce the number of B-cells in your blood and Y-90 ZEVALIN is given to treat your non-Hodgkin's lymphoma (NHL).

The ZEVALIN therapeutic regimen is used to treat patients with:

  • Low-grade or follicular B-cell NHL that has relapsed during or after treatment with other anticancer drugs.
  • Newly diagnosed follicular NHL following a response to initial anticancer therapy.

Patient Important Safety Information

What Is the Most Important Safety Information I Should Know About ZEVALIN Treatment?

The following section provides an overview of the most important safety information you should know about ZEVALIN, including side effects. Not all of the safety information about ZEVALIN treatment is included here. For complete safety information, please see the accompanying full prescribing information for ZEVALIN. Additional information may also be found on the ZEVALIN Website (www.ZEVALIN.com) or by speaking with your health care provider. Because ZEVALIN treatment includes the use of rituximab, please see the rituximab medication guide (www.rituxan.com).

WARNING: ZEVALIN TREATMENT CAN CAUSE SERIOUS SIDE EFFECTS:

  • Serious Infusion Reactions: Rituximab, alone or as part of the ZEVALIN treatment, may cause serious infusion reactions. Deaths have occurred within 24 hours of rituximab infusion, an important component of the ZEVALIN treatment. Tell your doctor or infusion nurse or get medical treatment right away if you develop fever or chills, a rash, itching, dizziness, swelling of your hands, feet or face, throat irritation or trouble breathing during or after receiving the ZEVALIN treatment.
  • Extended and Severe Decreases in Your Blood Counts (Cytopenias): Your doctor will monitor your blood counts after receiving the ZEVALIN treatment. Decreased blood counts can occur late and continue for more than 12 weeks after receiving ZEVALIN. Tell your doctor if you have a fever, feel too tired to do daily activities, feel weak, develop bruises or pinpoint red or purple spots on your skin, have unusual bleeding or notice blood in your urine or stool.
  • Severe Skin or Mucous Membrane Reactions: If you experience any reactions related to your skin or mucous membranes (e.g. mouth, nose), your infusion of rituximab and Y-90 ZEVALIN should be discontinued.

Dosing Warning: The dose of Y-90 ZEVALIN should not exceed 32.0 mCi (1184 MBq).

Additional Safety Information:

  • Risk of Developing Myelodysplastic Syndrome, Leukemia and Other Malignancies (Cancers): The radiation dose resulting from therapeutic exposure to Y-90 ZEVALIN may result in secondary malignancies.

    Myelodysplastic syndrome (MDS; a type of pre-cancerous bone marrow abnormality) and/or Acute Myelogenous Leukemia (AML, a type of cancer of the blood) were reported in 5.2% (11/211) of patients treated with Y-90 ZEVALIN for relapsed or refractory non-Hodgkin's lymphoma (NHL) in clinical studies, and 1.5% (8/535) of all patients included in the expanded-access trial, with median follow-up of 6.5 and 4.4 years, respectively. Among the 19 reported cases, the median time to diagnosis of MDS or AML was 1.9 years following the ZEVALIN therapy; however, the total incidence continues to increase.

    Among 204 newly diagnosed patients who received Y-90 ZEVALIN, following complete or partial response to initial anticancer therapy, 7 patients (3.4%) were diagnosed with MDS/AML after receiving ZEVALIN treatment, compared to one patient (0.5%, 1/205) in the control arm, with a median follow-up of 7.3 years. Deaths due to secondary new malignancies occurred in 8 (3.9%) patients treated with ZEVALIN compared to 3 (1.5%) patients in the control arm of the study. Deaths due to MDS or AML occurred in 5 (2.5%) patients treated with ZEVALIN compared to no patients in the control arm.

  • Infusion Site Leakage: ZEVALIN may leak from your vein or infusion site. Your doctor will monitor you during treatment and will stop the infusion and switch to another vein, if this occurs during treatment.
  • Immunization: Do not get a vaccine that contains live virus for at least 12 months following ZEVALIN treatment.
  • Precautions During and After Administration: Your doctor will discuss precautions with you to minimize radiation exposure.
  • Potential for Birth Defects: ZEVALIN therapy may cause harm to an unborn baby, please tell your doctor if you are pregnant or plan to become pregnant.
  • Reproductive Organs: There is a risk that ZEVALIN therapy will affect the male and female reproductive organs. Use birth control during treatment and for a minimum of 12 months following ZEVALIN therapy.
  • Nursing Mothers: Discontinue nursing during and after ZEVALIN treatment.
  • Adverse Reactions (Side Effects): The most common adverse reactions (≥10%) in clinical trials with ZEVALIN were: decreases in blood counts, tiredness, inflammation of the nose and upper throat, nausea (upset stomach), abdominal (stomach) pain, weakness, cough, diarrhea, and fever. The most serious adverse reactions of ZEVALIN are prolonged and severe reduction in the number of blood counts and secondary cancers.

    When administered following initial anticancer therapy, grade 3/4 adverse reactions of ZEVALIN include prolonged and severe decrease in blood counts (decrease in platelets [51%], decrease in neutrophils (a type of white blood cell) [41%], decrease in total white blood cells [36%], decrease in lymphocytes [18%], and decrease in red blood cells or hemoglobin [5%]), and secondary cancers (12.7%). Reductions in blood cells were more severe and more prolonged among 11 (5%) patients who received ZEVALIN after first-line fludarabine or a fludarabine-containing anticancer regimen as compared to patients receiving non-fludarabine-containing regimens. Grade 3/4 infections occurred in 8% of ZEVALIN-treated patients and in 2% of controls and included neutropenic sepsis (fever and infection due to decrease in the number of neutrophils [1%]), bronchitis, catheter sepsis (bacterial infection in the blood related to catheter), diverticulitis (inflammation in the intestines), shingles or blistering skin rash caused from herpes virus reactivation, flu, lower air passage infection, sinusitis (swelling of the sinuses), and upper air passage infection.

    Grade 3/4 adverse reactions of ZEVALIN in recurring NHL patients include prolonged and severe reduction of blood cells (decrease in platelets [63%], decrease in neutrophils [60%], decrease in red blood cells or hemoglobin [17%], and ecchymosis (small blue or purple patch on the skin or mucous membrane [<1%])) and secondary cancers (5.2%). Serious infections occurred in 3% of patients (urinary tract infection, febrile neutropenia, sepsis, pneumonia, cellulitis (type of skin infection), colitis (swelling of the large intestine), diarrhea, osteomyelitis (bone infection), and upper-air passage infection). Life-threatening infections were reported in 2% of patients (sepsis, empyema (collection of pus in a cavity in the body), pneumonia, febrile neutropenia, fever, and biliary stent-associated cholangitis (bile duct infection)).

Please click here to see the full Prescribing Information, including the BOXED WARNINGS, for ZEVALIN. Because ZEVALIN treatment includes the use of rituximab, please see the rituximab medication guide (www.rituxan.com).

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

ISI-1120-035604

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References:

1. Understanding Non-Hodgkin Lymphoma. Lymphoma Research Foundation Web site. http://www.lymphoma.org/atf/cf/%7Baaf3b4e5-2c43-404c-afe5-fd903c87b254%7D/LRF%20UNDERSTANDING%20NHL%20GUIDE2.PDF. Updated 2012. Accessed March 13, 2015.

2. Non-Hodgkin Lymphoma Overview. American Cancer Society Web site. http://www.cancer.org/acs/groups/cid/documents/webcontent/003067-pdf.pdf. Updated January 28, 2015. Accessed March 13, 2015.

3. Adult Non-Hodgkin Lymphoma Treatment (PDQ®). National Cancer Institute Web site. http://www.cancer.gov/cancertopics/pdq/treatment/adult-non-hodgkins/Patient/page1/print. Updated April 25, 2014. Accessed March 13, 2015.

4. NCI Dictionary of Cancer Terms. National Cancer Institute Web site. http://www.cancer.gov/dictionary. Accessed March 13, 2015.

5. ZEVALIN [package insert]. Irvine, CA: Spectrum Pharmaceuticals, Inc. 2013.