A 56-year-old asymptomatic woman with painless generalized lymphadenopathy has a node biopsy showing effaced architecture with closely packed back-to-back follicles composed predominantly of centrocytes. Cytogenetics show t(14;18). Staging reveals stage IIIA disease with normal hemoglobin, LDH and performance status. Most appropriate management?

• A Six cycles of R-CHOP
• B Observation until development of symptoms or end-organ compromise ✓
• C Autologous stem cell transplantation in first remission
• D Involved-field radiotherapy to all nodal sites

Explanation

Follicular lymphoma is incurable with current therapy and follows an indolent relapsing course. Randomised trials demonstrate no overall survival benefit from immediate immunochemotherapy in asymptomatic advanced stage disease, so observation until symptoms, cytopenias or bulky progressive disease is standard. R-CHOP is reserved for symptomatic or bulky disease, autologous transplant for chemosensitive relapse after prior lines, and radiotherapy for limited stage I to II 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.