Follicular lymphoma may come back after being in remission -- a period when you have few or no signs of cancer. If your cancer returns, it's called a "relapse."
Sometimes you get a relapse after many years in remission. Whenever it happens, you still have treatment options.
Why You Might Get a Relapse
After your treatment for follicular lymphoma, some cancer cells could have been left behind. There may have been too few for any scans or tests to see them.
Follicular lymphoma is a type of non-Hodgkin's lymphoma (NHL). NHLs tend to be slow-growing cancers. Treatment for cancer typically works better on fast-growing cells. This makes NHL cancers more likely to relapse.
Symptoms of a Relapse
You might have the same type of symptoms you had the first time you were diagnosed, or they might be different with your relapse. You could have:
- Swollen lymph nodes that last longer than a week
- Night sweats for more than a week
- Weight loss you can't explain
- Fatigue that gets worse over time
- Itching
- Diarrhea
- Pain that you can't explain
Your doctor will do tests or scans to help figure out if your symptoms are a relapse.
Treatment for Relapses
If your follicular lymphoma came back less than 5 years after you were first diagnosed, your doctor will likely suggest different treatment than you used the first time. If it's been longer than 5 years, your treatment may look very similar to the one you had originally.
To decide the best treatment, your doctor will look at:
- Which treatment you had originally
- How many times you've relapsed
- Complications or side effects that you had from previous treatments
- How long your remission lasted
- If you're having symptoms with your relapse
- Your age and overall health
Based on this information, your doctor might suggest:
Monoclonal antibodies. Drugs such as obinutuzumab (Gazyva) and rituximab (Rituxan) are often the first treatment for follicular lymphoma. Your doctor may decide to use them to treat a relapse.
Copanlisib (Aliquopa) or umbralisib (Ukoniq). These medications are targeted therapies. Doctors typically choose them after one or more other treatments have not worked.
Radioimmunotherapy. You get this medication -- Y90 ibritumomab tiuxetan (Zevalin) -- through an IV. It delivers radiation straight to a protein in cancer cells.
Bispecific antibodies. Mosunetuzumab-axgb (Lunsumio) binds the CD20 and CD3 proteins to help bring the cancer cells and T-cells together so that the T-cells can destroy the cancer cells.
CAR-T cell therapy. This treatment uses your own T-cells (a type of immune cell) plus chemotherapy to kill cancer cells. They include:
- Axicabtagene ciloleucel (Yescarta)
- Lisocabtagene maraleucel (Breyanzi)
- Tisagenlecleucel (Kymriah)
Stem cell transplant. Some relapsed follicular lymphomas respond best to a high dose of chemotherapy followed by a stem cell transplant. This is a procedure that replaces cells in your bone marrow with healthy cells.
