Front-line Management of Follicular Lymphoma


  • Samantha Hershenfeld, MD, FRCPC Division of Hematology Oncology, Odette Sunnybrook Cancer Centre, Toronto, ON University of Toronto
  • Jennifer Teichman, MD, FRCPC Division of Hematology Oncology, Odette Sunnybrook Cancer Centre, Toronto, ON University of Toronto
  • Neil L. Berinstein, MD, FRCPC Division of Hematology Oncology, Odette Sunnybrook Cancer Centre, Toronto, ON Professor of Medicine, University of Toronto, Toronto, ON Sunnybrook and Women’s Health Sciences Centre



Follicular lymphoma (FL) is the second most common type of non-Hodgkin lymphoma (NHL) in Western countries. Most patients have an indolent disease course with 10-year survival estimates of 80% among all patients in the rituximab era. However, risk stratification schema can identify subgroups of patients at higher risk of early death and/or progression following front-line therapy. In addition, histologic transformation to an aggressive NHL occurs in approximately 2% of patients per year. Many patients can initially be observed, but ultimately, most will be treated with multiple lines of therapy during their lifetimes. Current Health Canada-approved systemic treatment options include chemoimmunotherapy and lenalidomide plus rituximab. Phosphoinositide 3-kinase (PI3K) inhibitors were initially approved but were later withdrawn because of toxicity considerations. Newer therapies likely to impact care in Canada include bispecific T cell engagers (BiTEs) and chimeric antigen receptor (CAR)-T cell therapy.

Author Biographies

Samantha Hershenfeld, MD, FRCPC, Division of Hematology Oncology, Odette Sunnybrook Cancer Centre, Toronto, ON University of Toronto

Dr. Samantha Hershenfeld completed medical school, Internal Medicine and Hematology residency training at the University of Toronto. She is currently completing a fellowship in Hematology Oncology, with a focus on lymphoma and myeloma at the Odette Cancer Centre and Sunnybrook Health Sciences Centre. She is also currently pursuing a Master’s degree in Clinical Epidemiology at the Institute of  Health Policy, Management and Evaluation at the University of Toronto. She has an interest in health services research in hematologic malignancies.

Jennifer Teichman, MD, FRCPC, Division of Hematology Oncology, Odette Sunnybrook Cancer Centre, Toronto, ON University of Toronto

Dr. Teichman is a malignant hematologist at Sunnybrook Health Science Centre’s Odette Cancer Centre. She is a clinician teacher at the University of Toronto with a clinical focus in lymphoma and an academic focus in education and curriculum development in hematology. She completed advanced training in lymphoma including peripheral and cutaneous T cell lymphomas at the Odette Cancer Centre. She was the 2023 Sunnybrook Education Advisory Council Innovative Curriculum Award winner for the development of a hematology procedural skills teaching clinic.

Neil L. Berinstein, MD, FRCPC, Division of Hematology Oncology, Odette Sunnybrook Cancer Centre, Toronto, ON Professor of Medicine, University of Toronto, Toronto, ON Sunnybrook and Women’s Health Sciences Centre

Dr. Neil Berinstein is a Hematologist and Affiliate Scientist at the Odette Cancer Centre at Sunnybrook Hospital in Toronto, ON and a Professor of Medicine at the University of Toronto. He completed his Medical Degree at the University of Manitoba (1978), as well as fellowships in both Internal Medicine (1982) and Medical Oncology (1984) from the Royal College of Physicians of Canada, followed by a Postdoctoral research fellowship at Stanford University (1988). Dr. Berinstein’s research focuses on novel approaches to treat hematologic malignancy including combination immunotherapy and new targeted agents. He has led several multicentre translational clinical trials looking at novel therapeutics and identification of novel biomarkers.


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How to Cite

Hershenfeld S, Teichman J, Berinstein NL. Front-line Management of Follicular Lymphoma. Can Hematol Today [Internet]. 2024 Apr. 25 [cited 2024 May 20];3(1):5–16. Available from: