A 65-year-old woman is diagnosed with stage IV follicular lymphoma (FLIPI score 3, high risk). She is asymptomatic, has a small-volume disease, and normal organ function. According to current ESMO guidelines, what is the most appropriate initial approach?

• A R-CHOP immunochemotherapy immediately
• B Bendamustine-rituximab immediately regardless of symptoms
• C Rituximab monotherapy as first-line standard of care
• D Watchful waiting (active surveillance) until GELF criteria are met ✓

Explanation

Follicular lymphoma is indolent and incurable with standard therapy; immediate chemotherapy does not improve overall survival in asymptomatic, low-burden disease. ESMO and NCCN guidelines recommend active surveillance (watchful waiting) until GELF criteria are met (symptomatic disease, rapid progression, organ dysfunction, cytopenias, large-volume disease, bulky nodes ≥7 cm, or pleural/peritoneal effusion). Rituximab monotherapy may be considered in some settings but is not universally standard first-line.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.