Patients with follicular lymphoma who relapse within 2 years of initial therapy have an inferior prognosis compared with patients who do not relapse within 2 years, states Brad S. Kahl, MD. The probability of survival for the early relapsing population is about 50%, while it is greater than 90% for patients who have not relapsed. Younger patients who have relapsed may be considered for stem cell transplant, whereas a non-chemotherapy-based approach, such as targeted therapy, may be more prudent in older patients.

Idelalisib is an oral inhibitor of phosphoinositide 3-kinase, an enzyme central to B-cell survival. Idelalisib is approved for patients with recurrent follicular lymphoma who have had at least 2 prior lines of therapy. Adverse events include diarrhea, transaminitis, and colitis, although it is a relatively well-tolerated medication, notes Kahl. This therapy is ideal for older patients with refractory follicular lymphoma, Kahl notes.

Following a response to therapy, maintenance strategies have been explored for varying durations of treatment with rituximab. In general, although studies have shown incremental gains for longer durations of treatment, on average, 2 years of maintenance therapy is generally sufficient. Maintenance rituximab is generally administered once every 2 months for patients with follicular lymphoma.