A 48-year-old woman has painless axillary lymphadenopathy. Biopsy shows a nodular proliferation of centrocytes and centroblasts. She is completely asymptomatic with no B symptoms, no cytopenias, and no organ compromise. LDH is normal and PET-CT shows low-volume stage II disease. What is the most appropriate initial management?
- A Immediate R-CHOP chemotherapy
- B Observation with watchful waiting until symptomatic or progressive disease ✓
- C Autologous stem cell transplant in first remission
- D Total lymph node irradiation
Correct answer: B. Observation with watchful waiting until symptomatic or progressive disease
Explanation
Follicular lymphoma is the commonest indolent non-Hodgkin lymphoma, driven by t(14;18) with BCL2 overexpression blocking apoptosis. For advanced-stage asymptomatic disease, randomized trials show no survival benefit from immediate therapy, so observation until symptoms, bulky disease or organ compromise is standard. R-CHOP is reserved for symptomatic or progressive disease, and transplant is a relapse strategy, not front 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.