Follicular Lymphoma Watch and Wait — RACP Adult Medicine MCQ

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EasyHaematologyFollicular Lymphoma Watch and WaitRACP Adult Medicine

A 60-year-old man with stage IV follicular lymphoma (grade 1-2) is asymptomatic with low tumour burden. His haemoglobin is 132 g/L and there are no B symptoms. What is the recommended initial management?

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Correct answer: A — Watch and wait

Asymptomatic, low-tumour-burden follicular lymphoma (grade 1-2) should be managed with watch and wait (active surveillance). Multiple RCTs have shown no overall survival benefit from early treatment compared to observation in this setting. Treatment is initiated when the patient develops symptoms, high tumour burden (GELF criteria: any nodal mass >7 cm, ≥3 masses >3 cm, B symptoms, cytopaenias, effusions, organ compromise, high LDH), or histological transformation. Follicular lymphoma is generally incurable with standard therapy but has a median survival >15 years.

Reference: eTG – 2025 – Haematology; NCCN – 2025 – Follicular Lymphoma Guidelines