Treatment of Follicular Lymphoma at Advanced Stage (Lugano III/IV or Bulky) with High Tumor Burden

Clinical Scenario

This protocol addresses follicular lymphoma presenting at advanced stage — Lugano stage III or IV, or bulky localized disease — with high tumor burden, in patients who are symptomatic or have evidence of organ involvement. Patients in this setting require active treatment.

Treatment Approach

First-line management is based on induction immunochemotherapy combining an anti-CD20 antibody with a chemotherapy backbone. The specific regimen depends on patient characteristics and disease features. For patients who achieve a response after induction, maintenance therapy with an anti-CD20 antibody may follow.

The full regimen selection algorithm, patient-specific options, and maintenance details are in the complete protocol below.

Treatment Goal

The primary objective is achievement of at least a partial response — complete response or partial response — following induction. Maintenance therapy in responding patients is recommended to prolong progression-free survival.