First-line treatment of follicular lymphoma-a patient-oriented algorithm

Follicular lymphoma is an indolent and usually incurable disease. It has been, therefore, traditionally approached either by watch and wait or with single-agent treatments with the purpose of maintaining a good quality of life for a prolonged time. The emergence of more aggressive regimens including polychemotherapy, high-dose chemotherapy with stem-cell rescue and the positive effect of the addition of rituximab to the latter, have prompted many clinicians to abandon this minimalist strategy while trying to obtain a prolongation of survival or even cure by giving more intensive regimen at diagnosis or as soon as treatment was necessary. Because, at present, none of these new strategies was shown to lose their positive impact if used later in the treatment rather than upfront, we present here a management algorithm which should help clinicians in deciding which first-line regimen to use, taking into account the characteristics of the patients, of the disease and of the different treatments.