A 65-year-old woman with follicular lymphoma (grade 1–2, stage III, FLIPI score 3) is asymptomatic, with no B symptoms, and has stable low-volume disease. Which approach is most appropriate at initial presentation?

• A Immediate R-CHOP chemotherapy
• B Rituximab maintenance therapy
• C Autologous stem cell transplant
• D Watch and wait (active surveillance) ✓

Explanation

Low-grade follicular lymphoma is generally indolent and incurable with conventional chemotherapy. In asymptomatic patients without bulky disease, cytopenias, or organ compromise, watch-and-wait (active surveillance) is the standard initial management per ESMO and NCCN guidelines — several trials including the RESORT trial demonstrated no survival benefit of early rituximab treatment versus watchful waiting. Treatment is initiated when the patient becomes symptomatic or develops criteria per GELF/BNLI criteria.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.