eMedicine Specialties > Hematology > Stem Cells and Disorders

Lymphoma, Follicular: Follow-up

Author: Cesar O Freytes, MD, FACP, Director of Bone Marrow Transplant Program, Professor, Department of Internal Medicine, Division of Hematology, University of Texas Health Science Center at San Antonio
Coauthor(s): Julianna A Burzynski, PharmD, BCOP, BCPS, Clinical Pharmacy Specialist in Hematology/Oncology, Mayo Clinic
Contributor Information and Disclosures

Updated: Nov 3, 2009

Follow-up

Further Inpatient Care

  • Most patients with follicular lymphoma do not require hospitalization during the early stages of the disease.
  • Patients with bulky disease at the time of treatment should be followed closely for tumor lysis syndrome. Allopurinol should be considered in these patients. Institute close follow-up of renal function and electrolyte balance.

Further Outpatient Care

  • Patients should be monitored periodically to facilitate avoidance or early treatment of complications of the disease.
  • Patients should be asked about the development of systemic symptoms such as fever, weight loss, and asthenia. These symptoms may herald progression of the disease or transformation to more aggressive intermediate-grade lymphoma.
  • The physical examination should include a complete examination of the lymph nodes and reticuloendothelial system. Particular attention should be given to the abdominal examination, looking for the presence of splenomegaly or hepatosplenomegaly.
  • Laboratory evaluation should include complete blood counts and serum chemistries. The serum chemistries should include liver function tests to be able to detect complications such as biliary obstruction and BUN and creatinine to detect ureteral obstruction and metabolic abnormalities such as hyperuricemia and hypercalcemia.

Complications

  • Complications due to increased adenopathy causing obstruction, such as biliary obstruction, ureteral obstruction, and bronchial obstruction, should be considered during the follow-up monitoring of patients with follicular lymphomas.

Prognosis

  • The overall survival rate of patients with follicular lymphoma is 72-77% at 5 years.
  • Median survival is approximately 8-10 years.
  • Patients who have 4 or more of the following adverse prognostic factors have a 10-year survival rate of approximately 36%:
    • Age 60 years or older
    • Ann Arbor Stage III or IV
    • LDH above the upper limit of normal at diagnosis
    • Hemoglobin less than 12 g/dL
    • Presence of more than 4 extranodal sites of disease

Patient Education

  • Patients should be educated regarding the signs and symptoms of progression of the disease, including new systemic symptoms, new lymphadenopathy, or rapidly enlarging lymphadenopathy.
  • Similar to patients with chronic lymphocytic leukemia, patients with follicular lymphoma also are more prone to infections and should be instructed to contact their physician early if they develop signs or symptoms of infection.

Miscellaneous

Medicolegal Pitfalls

  • The most common pitfall is to confuse follicular lymphomas with other types of lymphomas. The diagnosis of lymphomas is complex, and tissue biopsies should be reviewed by pathologists with experience in interpreting lymph node biopsies and other diagnostic material.
  • Supporting tests, such as immunophenotyping and cytogenetics, should be performed, especially if some doubt exists regarding the diagnosis.
 


More on Lymphoma, Follicular

Overview: Lymphoma, Follicular
Differential Diagnoses & Workup: Lymphoma, Follicular
Treatment & Medication: Lymphoma, Follicular
Follow-up: Lymphoma, Follicular
Multimedia: Lymphoma, Follicular
References
Further Reading
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References

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Keywords

follicular lymphoma, non-Hodgkin's lymphoma, nodular lymphomas, low-grade lymphomas, indolent lymphomas, non-Hodgkin lymphoma, lymphoid tissue, lymph nodes, spleen, bone marrow, primary extranodal lymphoma

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Contributor Information and Disclosures

Author

Cesar O Freytes, MD, FACP, Director of Bone Marrow Transplant Program, Professor, Department of Internal Medicine, Division of Hematology, University of Texas Health Science Center at San Antonio
Cesar O Freytes, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Research, American Association for the Advancement of Science, American Association of Blood Banks, American College of Physicians, American Society for Blood and Marrow Transplantation, American Society of Hematology, International Society for Experimental Hematology, and New York Academy of Sciences
Disclosure: Genzyme Grant/research funds Review panel membership; Otsuka Consulting fee Review panel membership

Coauthor(s)

Julianna A Burzynski, PharmD, BCOP, BCPS, Clinical Pharmacy Specialist in Hematology/Oncology, Mayo Clinic
Julianna A Burzynski, PharmD, BCOP, BCPS is a member of the following medical societies: American College of Clinical Pharmacy
Disclosure: Nothing to disclose.

Medical Editor

Koyamangalath Krishnan, MD, FRCP, FACP, Paul Dishner Endowed Chair of Excellence in Medicine, Professor of Medicine and Chief of Hematology-Oncology, Program Director, Hematology-Oncology Fellowship, James H Quillen College of Medicine at East Tennessee State University
Koyamangalath Krishnan, MD, FRCP, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Society of Hematology, and Royal College of Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Wendy Hu, MD, Consulting Staff, Department of Hematology/Oncology and Bone Marrow Transplantation, Huntington Memorial Medical Center
Wendy Hu, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Blood and Marrow Transplantation, American Society of Hematology, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

CME Editor

Rajalaxmi McKenna, MD, FACP, Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

Emmanuel C Besa, MD, Professor, Department of Medicine, Division of Hematologic Malignancies, Kimmel Cancer Center, Thomas Jefferson University
Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Hematology, and New York Academy of Sciences
Disclosure: Nothing to disclose.

 
 
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