Treatment of Primary Ovarian Lymphoma in Follicular Lymphoma
Clinical scenario
Primary ovarian lymphoma classified as follicular lymphoma (FL) is a rare
indolent B-cell presentation. The treatment pathway is determined primarily by disease stage and
tumour burden, with meaningfully different strategies applied at each level.
Defining condition
This protocol applies to patients with primary ovarian lymphoma whose histology is confirmed as
follicular lymphoma. Stage (limited versus advanced) and the presence or
absence of symptoms and high tumour burden are the key clinical determinants that drive treatment
selection.
Treatment approach — overview only
Approaches include involved-site radiation therapy (ISRT) for appropriately staged limited-stage
disease, active observation as a valid option in selected asymptomatic cases, and immunotherapy-based
systemic regimens for symptomatic or higher-burden disease. The complete stage-by-stage algorithm,
full regimen options, and maintenance strategies are available in the structured protocol below.
References
DOI: 10.1016/j.annonc.2025.07.014
- Patients with FDG–PET–CT and BM-staged limited-stage I or contiguous stage II FL can be treated with 24 Gy ISRT with or without R as first-line therapy [II, B].
- Palliative ISRT 4–8 Gy can be considered where long-term disease control is less critical than minimising toxicity e.g. elderly or frail patients [IV, B].
- Active observation [I, A].
- R induction therapy given weekly for 4 weeks with or without R maintenance therapy given every 2 months for 12 doses [I, B].
- R— or obinutuzumab (O)—bendamustine [I, B].
- R- or O-CHOP [I, B].
- R- or O-CVP [I, B].
- R—lenalidomide [I, B; not EMA or FDA approved].
- R 375 mg/m² induction therapy given weekly for 4 weeks followed by R maintenance therapy given every 2 months for 12 doses [III, B].
- Following immunoChT induction therapy, maintenance therapy with R or O given every 2 months (subcutaneous or intravenous) for 2 years may be considered [I, C].
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