title: Advanced-stage III/IV follicular lymphoma: treatment strategies for individual patients.
abstract: BACKGROUND
  In patients with advanced-stage III/IV follicular lymphoma (FL), there are many treatment options available. The current challenge is to choose the optimal strategy for the individual patient.
  
  
  METHODS
  The literature was reviewed with respect to treatment strategies in patients with advanced FL by screening the PubMed databank.
  
  
  RESULTS
  In advanced-stage III/IV FL, median survival may approach 8-10 years. Treatment strategies include a watch-and-wait strategy, chemoimmunotherapy, monotherapy with rituximab, and - as an experimental approach so far - radioimmunotherapy. The use of autologous hematopoietic stem cell transplantation (HSCT) for patients in first remission or chemosensitive relapse prolongs progression-free survival while the effect on overall survival remains unclear compared to standard chemotherapy. However, long-term results are flawed by high relapse rates and risk of secondary malignancies. In patients with relapsed/chemoresistant disease, allogeneic HSCT constitutes the only curative approach but is associated with high treatment-related mortality. In the palliative setting, low-dose involved-field irradiation constitutes an effective treatment option in order to control local symptoms with potential long-lasting response.
  
  
  CONCLUSIONS
  In case of advanced-disease FL, asymptomatic patients can be managed expectantly. In symptomatic patients, chemoimmunotherapy is regarded as standard therapy. In symptomatic elderly patients with relevant comorbidities, rituximab +/- single-agent chemotherapy, or low-dose involved-field radiotherapy might be appropriate. For younger patients with chemoresistant/relapsed disease, allogeneic HSCT might be considered, since advances in supportive care and better patient selection have resulted in improved outcomes.
authors.affiliation: Department of Radiation Oncology, University of Tübingen, Tübingen, Germany. frank.heinzelmann@med.uni-tuebingen.de
authors.forename: Frank
authors.initials: F
authors.lastname: Heinzelmann
authors.forename: Hellmut
authors.initials: H
authors.lastname: Ottinger
authors.forename: Marianne
authors.initials: M
authors.lastname: Engelhard
authors.forename: Martin
authors.initials: M
authors.lastname: Soekler
authors.forename: Michael
authors.initials: M
authors.lastname: Bamberg
authors.forename: Martin
authors.initials: M
authors.lastname: Weinmann
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D003131:Combined Modality Therapy; D006801:Humans; D008224:Lymphoma, Follicular / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D009367:Neoplasm Staging; D016499:Radioimmunotherapy; D000069283:Rituximab; D015996:Survival Rate
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab