Follicular Non-Hodgkin Lymphoma: First Relapse and Beyond


  • Mary-Margaret Keating, MD Division of Hematology and Hematologic Oncology, QEII Health Science Center, Halifax, Nova Scotia



Follicular lymphoma (FL) is the most common indolent subtype of non-Hodgkin Lymphoma (NHL) and the second most common type of lymphoma overall. In Canada the age‑standardized incidence of FL is 38.3 cases per million individuals per year with mean age at diagnosis of 60 and similar incidence in men and women. Follicular lymphoma is treatable but not curable with systemic therapy yet it maintains a median overall survival (OS) of approximately 20 years. Historically, this long median survival has been maintained through periods of watchful waiting and subsequent treatment with chemoimmunotherapy when the disease burden becomes symptomatic. Serial relapses with progressively shorter remissions and more resistant disease is the usual natural history for FL. The management of relapsed FL remains controversial and the decision on next line of therapy is a rapidly evolving area, with the old standard repetition of chemoimmunotherapy being contested by new targeted therapies. There remains a challenge for Canadian patients to access these novel therapies outside of clinical trials and access programs. This review will present a treatment approach for relapsed FL taking into consideration Canadian funding patterns, in addition to reviewing the novel drugs with the highest level and most mature evidence to date.

Author Biography

Mary-Margaret Keating, MD, Division of Hematology and Hematologic Oncology, QEII Health Science Center, Halifax, Nova Scotia

Dr. Mary-Margaret Keating is a hematologist and assistant professor of medicine, in the Division of Hematology at the QEII Health Science Center in Halifax, Nova Scotia. She has a clinical focus in lymphoma and is involved in selecting and overseeing clinical trials for this disease area. She earned a master’s in medical education from Acadia University and has a passion for teaching medical students, residents and patients. She is the program director for the hematology residency training program and the unit head for the skilled clinician course at Dalhousie Medical School.


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How to Cite

Keating M-M. Follicular Non-Hodgkin Lymphoma: First Relapse and Beyond. Can Hematol Today [Internet]. 2024 Apr. 25 [cited 2024 Jun. 19];3(1):24–32. Available from: