This protocol applies to patients with relapsed follicular lymphoma who present with low tumor burden and remain asymptomatic — a clinically distinct group whose management differs from symptomatic or high-burden relapse.
The combination of asymptomatic status and low tumor burden at relapse defines this population. A key determinant of the clinical approach is whether the relapse is localized or disseminated, as each distribution supports a different strategy.
For localized relapse, a radiation-based local strategy is among the options considered. For disseminated disease with low tumor burden, a conservative or targeted approach may be appropriate — the full protocol specifies the criteria, options, and sequencing for each setting.
DOI: 10.3390/cancers18030395
Asymptomatic patients with non-localized relapse and low tumor burden can be managed with observation (1B) or rituximab monotherapy (1B).
Localized relapses, without other risk factors, can be treated with involved-site radiotherapy (ISRT) even at low doses (2B).
Localized relapse, using PET staging, can be treated with ISRT at a dose of 24 Gy, although a dose of 4 Gy may be a useful alternative for sustained local control and minimized toxicity (2B).
Disseminated disease with low tumor burden can also be managed with observation or rituximab monotherapy (1B).
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