A 61-year-old woman is found to have painless axillary and inguinal lymphadenopathy. Node biopsy shows a predominantly follicular pattern of small cleaved cells; immunostaining is CD10+, BCL2+, BCL6+. PET-CT shows stage III disease with low tumour burden. She is completely asymptomatic with normal haemoglobin and LDH. Most appropriate management?
- A Rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone (R-CHOP)
- B Involved-field radiotherapy to all nodal sites
- C Observation with regular follow-up until symptoms or organ compromise develop ✓
- D Autologous stem cell transplantation in first remission
Correct answer: C. Observation with regular follow-up until symptoms or organ compromise develop
Explanation
Grade 1 to 2 follicular lymphoma is incurable with current therapy but follows an indolent course, and randomised studies show no survival advantage for immediate chemotherapy over observation in asymptomatic advanced-stage patients with low tumour burden. Standard practice is watchful waiting with periodic reassessment, initiating immunochemotherapy at symptomatic progression. Upfront R-CHOP (option A) exposes her to toxicity without proven benefit, and transplant is reserved for relapsed or transformed disease.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.