Relapsed Follicular Lymphoma in 2026: Evolving Treatment Strategies in the Canadian Context
Abstract
Follicular lymphoma (FL) is the most common indolent lymphoma, characterized by a relapsing-remitting course over many years and repeated need for systemic therapy.1 Although outcomes for many patients are excellent, with median overall survival (OS) now exceeding 20 years, a subset of patients experiences early relapse, treatment resistance, or histologic transformation associated with inferior outcomes.2 Management of relapsed disease has relied on sequential chemoimmunotherapy, with treatment selection guided by duration of remission and patient fitness. This paradigm is now evolving with the availability of novel therapies such as chimeric antigen receptor (CAR) T-cell therapy.3 In addition, maturation of data on lenalidomide-based triplet combinations and the emergence of bispecific antibodies are expected to further reshape treatment algorithms, pending Canadian funding decisions. This review outlines an updated approach to relapsed FL, focusing on treatment sequencing, evolving therapeutic strategies, and Canadian access considerations.
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