{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:29:09Z","timestamp":1792787349774,"version":"4.5.0"},"reference-count":113,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T00:00:00Z","timestamp":1769472000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Follicular lymphoma (FL) is the second most common B-cell lymphoma in Western countries, typically presenting as an indolent disease with prolonged overall survival. Despite favorable initial responses to therapy, most patients experience relapse, and early progression is associated with poor outcomes. Methods: This guideline provides evidence-based recommendations from the Spanish GELTAMO group on the diagnosis, staging, treatment, and follow-up of FL. A systematic literature review was conducted, and recommendations were graded according to the GRADE system. Results: Histopathological diagnosis should be based on excisional biopsy. PET-CT is recommended for staging and response evaluation. For localized disease, involved-site radiotherapy (ISRT) remains the treatment of choice. In asymptomatic patients with advanced-stage disease and low tumor burden, a watch-and-wait approach is appropriate, although rituximab monotherapy is also acceptable. For advanced-stage disease with high tumor burden, immunochemotherapy with anti-CD20 antibodies (rituximab or obinutuzumab) combined with CHOP, CVP, or bendamustine is recommended, followed by maintenance therapy. Management of relapsed disease is tailored based on tumor burden, treatment history, and timing of relapse. Although novel immunotherapies (CAR-T therapy and bispecific antibodies) are emerging as promising options, autologous stem cell therapies may still be a valid option in young patients with early relapse who are sensitive to immunochemotherapy. Conclusions: FL is a heterogeneous disease requiring individualized management strategies. Recent advances in immunotherapy and molecular diagnostics are reshaping the therapeutic landscape. These updated GELTAMO recommendations aim to provide practical guidance for optimal FL management in clinical practice.<\/jats:p>","DOI":"10.3390\/cancers18030395","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T15:41:56Z","timestamp":1769528516000},"page":"395","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Guidelines for Diagnosis, Treatment, and Follow-Up of Patients with Follicular Lymphoma-Spanish Lymphoma Group (GELTAMO) 2026"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-6459-5695","authenticated-orcid":false,"given":"Francisco-Javier","family":"Pe\u00f1alver","sequence":"first","affiliation":[{"name":"Department of Hematology, Hospital Universitario Fundaci\u00f3n Alcorc\u00f3n, 28922 Alcorc\u00f3n, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Magnano","sequence":"additional","affiliation":[{"name":"Department of Hematology, Hospital Cl\u00ednic de Barcelona, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Alonso-\u00c1lvarez","sequence":"additional","affiliation":[{"name":"Department of Hematology, Instituto de Investigaci\u00f3n Sanitaria del Principado de Asturias (ISPA)\u2013Hospital Universitario Central de Asturias, 33011 Oviedo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Jim\u00e9nez-Ubieto","sequence":"additional","affiliation":[{"name":"Department of Hematology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armando","family":"L\u00f3pez-Guillermo","sequence":"additional","affiliation":[{"name":"Department of Hematology, Hospital Cl\u00ednic de Barcelona, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7168-6538","authenticated-orcid":false,"given":"Juan-Manuel","family":"Sancho","sequence":"additional","affiliation":[{"name":"Department of Hematology, ICO-IJC Hospital Germans Trias i Pujol, 08916\u00a0Badalona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,27]]},"reference":[{"key":"ref_1","unstructured":"Swerdlow, S.H., Campo, E., Harris, N.L., Jaffe, E.S., Pileri, S.A., Stein, H., and Thiele, J. (2017). World Health Organization Classification of Tumours of Haematopoietic and Lymphoid Tissues."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1182\/blood.2022015851","article-title":"The International Consensus Classification of Mature Lymphoid Neoplasms: A report from the Clinical Advisory Committee","volume":"140","author":"Campo","year":"2022","journal-title":"Blood"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1720","DOI":"10.1038\/s41375-022-01620-2","article-title":"The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: Lymphoid Neoplasms","volume":"36","author":"Alaggio","year":"2022","journal-title":"Leukemia"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1007\/s00277-020-03918-6","article-title":"RELINF: Prospective epidemiological registry of lymphoid neoplasms in Spain. A project from the GELTAMO group","volume":"99","author":"Panizo","year":"2020","journal-title":"Ann. Hematol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1038\/s41408-020-00340-z","article-title":"Follicular lymphoma in the modern era: Survival, treatment outcomes, and identification of high-risk subgroups","volume":"10","author":"Batlevi","year":"2020","journal-title":"Blood Cancer J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1136\/bmj.39489.470347.AD","article-title":"GRADE: An emerging consensus on rating quality of evidence and strength of recommendations","volume":"336","author":"Guyatt","year":"2008","journal-title":"BMJ"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"245","DOI":"10.5858\/arpa.2013-0674-RA","article-title":"Systematic review of the effectiveness of fine-needle aspiration and\/or core needle biopsy for subclassifying lymphoma","volume":"139","author":"Frederiksen","year":"2015","journal-title":"Arch. Pathol. Lab. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.1007\/s00277-016-2704-0","article-title":"Core needle biopsies and surgical excision biopsies in the diagnosis of lymphoma-experience at the Lymph Node Registry Kiel","volume":"95","author":"Johl","year":"2016","journal-title":"Ann. Hematol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"325","DOI":"10.17219\/acem\/31804","article-title":"PET\/CT Assessment of Follicular Lymphoma and High Grade B Cell Lymphoma\u2014Good Correlation with Clinical and Histological Features at Diagnosis","volume":"24","author":"Novelli","year":"2015","journal-title":"Adv. Clin. Exp. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1093\/ajcp\/103.4.472","article-title":"Comparison of cytogenetic analysis, southern analysis, and polymerase chain reaction for the detection of t(14; 18) in follicular lymphoma","volume":"103","author":"Horsman","year":"1995","journal-title":"Am. J. Clin. Pathol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3806","DOI":"10.1182\/blood.V99.10.3806","article-title":"Cytomorphologic, immunohistochemical, and cytogenetic profiles of follicular lymphoma: 2 types of follicular lymphoma grade 3","volume":"99","author":"Ott","year":"2002","journal-title":"Blood"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1038\/leu.2011.266","article-title":"High rate of TNFRSF14 gene alterations related to 1p36 region in de novo follicular lymphoma and impact on prognosis","volume":"26","author":"Launay","year":"2012","journal-title":"Leukemia"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1038\/ng.2856","article-title":"Integrated genomic analysis identifies recurrent mutations and evolution patterns driving the initiation and progression of follicular lymphoma","volume":"46","author":"Okosun","year":"2014","journal-title":"Nat. Genet."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1604","DOI":"10.1182\/blood-2012-09-457283","article-title":"Hierarchy in somatic mutations arising during genomic evolution and progression of follicular lymphoma","volume":"121","author":"Green","year":"2013","journal-title":"Blood"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.celrep.2013.12.027","article-title":"Genetics of follicular lymphoma transformation","volume":"6","author":"Pasqualucci","year":"2014","journal-title":"Cell Rep."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1110","DOI":"10.1200\/JCO.1997.15.3.1110","article-title":"Comparison in low-tumor-burden follicular lymphomas between an initial no-treatment policy, prednimustine, or interferon alfa: A randomized study from the Groupe d\u2019Etude des Lymphomes Folliculaires. Groupe d\u2019Etude des Lymphomes de l\u2019Adulte","volume":"15","author":"Brice","year":"1997","journal-title":"J. Clin. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1111\/j.1365-2141.2011.08969.x","article-title":"Guidelines on the investigation and management of follicular lymphoma","volume":"156","author":"McNamara","year":"2012","journal-title":"Br. J. Haematol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"4480","DOI":"10.1200\/JCO.2010.28.4786","article-title":"Long-term follow-up of patients with follicular lymphoma receiving single-agent rituximab at two different schedules in trial SAKK 35\/98","volume":"28","author":"Martinelli","year":"2010","journal-title":"J. Clin. Oncol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"3059","DOI":"10.1200\/JCO.2013.54.8800","article-title":"Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: The Lugano classification","volume":"32","author":"Cheson","year":"2014","journal-title":"J. Clin. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1111\/bjh.14839","article-title":"Bone marrow biopsies do not impact response assessment for follicular lymphoma patients treated on clinical trials","volume":"179","author":"Rutherford","year":"2017","journal-title":"Br. J. Haematol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1182\/bloodadvances.2019001261","article-title":"Impact of bone marrow biopsy on response assessment in immunochemotherapy-treated lymphoma patients in GALLIUM and GOYA","volume":"4","author":"Rutherford","year":"2020","journal-title":"Blood Adv."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"3390","DOI":"10.1002\/cncr.33660","article-title":"Surveillance imaging during first remission in follicular lymphoma does not impact overall survival","volume":"127","author":"Goldman","year":"2021","journal-title":"Cancer"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2263","DOI":"10.1007\/s00277-018-3362-1","article-title":"Routine surveillance imaging in follicular lymphoma","volume":"97","author":"Sorigue","year":"2018","journal-title":"Ann. Hematol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1038\/s41375-022-01803-x","article-title":"Real-life disease monitoring in follicular lymphoma patients using liquid biopsy ultra-deep sequencing and PET\/CT","volume":"37","author":"Poza","year":"2023","journal-title":"Leukemia"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1182\/blood.2024027727","article-title":"Combined PET and ctDNA response as a predictor of POD24 for follicular lymphoma after first-line induction treatment","volume":"146","author":"Claudel","year":"2025","journal-title":"Blood"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1016\/S1470-2045(15)00169-2","article-title":"Integration of gene mutations in risk prognostication for patients receiving first-line immunochemotherapy for follicular lymphoma: A retrospective analysis of a prospective clinical trial and validation in a population-based registry","volume":"16","author":"Pastore","year":"2015","journal-title":"Lancet Oncol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1182\/blood-2016-05-717355","article-title":"Clinicogenetic risk models predict early progression of follicular lymphoma after first-line immunochemotherapy","volume":"128","author":"Jurinovic","year":"2016","journal-title":"Blood"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1016\/S1470-2045(18)30102-5","article-title":"A gene-expression profiling score for prediction of outcome in patients with follicular lymphoma: A retrospective training and validation analysis in three international cohorts","volume":"19","author":"Huet","year":"2018","journal-title":"Lancet Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"3618","DOI":"10.1200\/JCO.2016.66.9440","article-title":"Baseline Metabolic Tumor Volume Predicts Outcome in High-Tumor-Burden Follicular Lymphoma: A Pooled Analysis of Three Multicenter Studies","volume":"34","author":"Meignan","year":"2016","journal-title":"J. Clin. Oncol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2449","DOI":"10.1182\/blood-2017-11-816298","article-title":"Prognostic model for high-tumor-burden follicular lymphoma integrating baseline and end-induction PET: A LYSA\/FIL study","volume":"131","author":"Cottereau","year":"2018","journal-title":"Blood"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"100865","DOI":"10.1016\/j.blre.2021.100865","article-title":"Past, present and future of prognostic scores in follicular lymhoma","volume":"50","author":"Mozas","year":"2021","journal-title":"Blood Rev."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1606","DOI":"10.1182\/bloodadvances.2022007949","article-title":"Evaluation of 4 prognostic indices in follicular lymphoma treated in first line with immunochemotherapy","volume":"7","author":"Bento","year":"2023","journal-title":"Blood Adv."},{"key":"ref_33","first-page":"783","article-title":"Prognosis of follicular lymphoma: A predictive model based on a retrospective analysis of 987 cases","volume":"95","author":"Federico","year":"2005","journal-title":"Intergruppo Italiano Linfomi. Blood"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1182\/blood-2003-12-4434","article-title":"Follicular Lymphoma International Prognostic Index","volume":"104","author":"Roy","year":"2004","journal-title":"Blood"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"4555","DOI":"10.1200\/JCO.2008.21.3991","article-title":"Follicular lymphoma international prognostic index 2: A new prognostic index for follicular lymphoma developed by the international follicular lymphoma prognostic factor project","volume":"27","author":"Federico","year":"2009","journal-title":"J. Clin. Oncol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1182\/blood-2017-11-816405","article-title":"A simplified scoring system in de novo follicular lymphoma treated initially with immunochemotherapy","volume":"132","author":"Bachy","year":"2018","journal-title":"Blood"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1503","DOI":"10.1002\/ajh.25973","article-title":"Follicular Lymphoma Evaluation Index (FLEX): A new clinical prognostic model that is superior to existing risk scores for predicting progression-free survival and early treatment failure after frontline immunochemotherapy","volume":"95","author":"Mir","year":"2020","journal-title":"Am. J. Hematol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"3194","DOI":"10.1200\/JCO.2011.35.0736","article-title":"Positron emission tomography-computed tomography (PET-CT) after induction therapy is highly predictive of patient outcome in follicular lymphoma: Analysis of PET-CT in a subset of PRIMA trial participants","volume":"29","author":"Trotman","year":"2011","journal-title":"J. Clin. Oncol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1093\/annonc\/mdt562","article-title":"The prognostic role of post-induction FDG-PET in patients with follicular lymphoma: A subset analysis from the FOLL05 trial of the Fondazione Italiana Linfomi (FIL)","volume":"25","author":"Luminari","year":"2014","journal-title":"Ann. Oncol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1200\/JCO.21.01234","article-title":"Response-Adapted Postinduction Strategy in Patients with Advanced-Stage Follicular Lymphoma: The FOLL12 Study","volume":"40","author":"Luminari","year":"2022","journal-title":"J. Clin. Oncol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1016\/S1470-2045(20)30686-0","article-title":"4 Gy versus 24 Gy radiotherapy for follicular and marginal zone lymphoma (FoRT): Long-term follow-up of a multicentre, randomised, phase 3, non-inferiority trial","volume":"22","author":"Hoskin","year":"2021","journal-title":"Lancet Oncol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.radonc.2011.05.013","article-title":"Reduced dose radiotherapy for local control in non-Hodgkin lymphoma: A randomised phase III trial","volume":"100","author":"Lowry","year":"2011","journal-title":"Radiother. Oncol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1016\/S1470-2045(14)70036-1","article-title":"4 Gy versus 24 Gy radiotherapy for patients with indolent lymphoma (FORT): A randomised phase 3 non-inferiority trial","volume":"15","author":"Hoskin","year":"2014","journal-title":"Lancet Oncol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"4185","DOI":"10.1182\/bloodadvances.2021004939","article-title":"Excellent response to very-low-dose radiation (4 Gy) for indolent B-cell lymphomas: Is 4 Gy suitable for curable patients?","volume":"5","author":"Imber","year":"2021","journal-title":"Blood Adv."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2918","DOI":"10.1200\/JCO.2018.77.9892","article-title":"Randomized Trial of Systemic Therapy After Involved-Field Radiotherapy in Patients with Early-Stage Follicular Lymphoma: TROG 99.03","volume":"36","author":"MacManus","year":"2018","journal-title":"J. Clin. Oncol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e160","DOI":"10.1097\/HS9.0000000000000160","article-title":"Rituximab With Involved Field Irradiation for Early-stage Nodal Follicular Lymphoma: Results of the MIR Study","volume":"2","author":"Herfarth","year":"2018","journal-title":"Hemasphere"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e861","DOI":"10.1097\/HS9.0000000000000861","article-title":"Risk Factors of Progression in Low-tumor Burden Follicular Lymphoma Initially Managed by Watch and Wait in the Era of PET and Rituximab","volume":"7","author":"Rodier","year":"2023","journal-title":"Hemasphere"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"10","DOI":"10.7326\/0003-4819-90-1-10","article-title":"No initial therapy for stage III and IV non-Hodgkin\u2019s lymphomas of favorable histologic types","volume":"90","author":"Portlock","year":"1979","journal-title":"Ann. Intern. Med."},{"key":"ref_49","first-page":"11","article-title":"The treatment of indolent lymphomas: Watchful waiting v aggressive combined modality treatment","volume":"25","author":"Young","year":"1988","journal-title":"Semin. Hematol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1016\/S0140-6736(03)14110-4","article-title":"Long-term effect of a watch and wait policy versus immediate systemic treatment for asymptomatic advanced-stage non-Hodgkin lymphoma: A randomised controlled trial","volume":"362","author":"Ardeshna","year":"2003","journal-title":"Lancet"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"e335","DOI":"10.1016\/S2352-3026(25)00034-1","article-title":"Early rituximab monotherapy versus watchful waiting for advanced stage, asymptomatic, low tumour burden follicular lymphoma: Long-term results of a randomised, phase 3 trial","volume":"12","author":"Northend","year":"2025","journal-title":"Lancet Haematol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"4416","DOI":"10.1182\/blood-2003-10-3411","article-title":"Prolonged treatment with rituximab in patients with follicular lymphoma significantly increases event-free survival and response duration compared with the standard weekly x 4 schedule","volume":"103","author":"Ghielmini","year":"2004","journal-title":"Blood"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1016\/S0140-6736(12)61763-2","article-title":"Bendamustine plus rituximab versus CHOP plus rituximab as first-line treatment for patients with indolent and mantle-cell lymphomas: An open-label, multicentre, randomised, phase 3 non-inferiority trial","volume":"381","author":"Rummel","year":"2013","journal-title":"Lancet"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1506","DOI":"10.1200\/JCO.2012.45.0866","article-title":"R-CVP versus R-CHOP versus R-FM for the initial treatment of patients with advanced-stage follicular lymphoma: Results of the FOLL05 trial conducted by the Fondazione Italiana Linfomi","volume":"31","author":"Federico","year":"2013","journal-title":"J. Clin. Oncol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1200\/JCO.2017.74.1652","article-title":"Long-Term Results of the FOLL05 Trial Comparing R-CVP Versus R-CHOP Versus R-FM for the Initial Treatment of Patients With Advanced-Stage Symptomatic Follicular Lymphoma","volume":"36","author":"Luminari","year":"2018","journal-title":"J. Clin. Oncol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"4579","DOI":"10.1200\/JCO.2007.13.5376","article-title":"Phase III study of R-CVP compared with cyclophosphamide, vincristine, and prednisone alone in patients with previously untreated advanced follicular lymphoma","volume":"26","author":"Marcus","year":"2008","journal-title":"J. Clin. Oncol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"3725","DOI":"10.1182\/blood-2005-01-0016","article-title":"Frontline therapy with rituximab added to the combination of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) significantly improves the outcome for patients with advanced-stage follicular lymphoma compared with therapy with CHOP alone: Results of a prospective randomized study of the German Low-Grade Lymphoma Study Group","volume":"106","author":"Hiddemann","year":"2005","journal-title":"Blood"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1986","DOI":"10.1200\/JCO.2006.06.4618","article-title":"Rituximab added to first-line mitoxantrone, chlorambucil, and prednisolone chemotherapy followed by interferon maintenance prolongs survival in patients with advanced follicular lymphoma: An East German Study Group Hematology and Oncology Study","volume":"25","author":"Herold","year":"2007","journal-title":"J. Clin. Oncol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.3324\/haematol.2012.082412","article-title":"Long-term follow up of the FL2000 study comparing CHVP-interferon to CHVP-interferon plus rituximab in follicular lymphoma","volume":"98","author":"Bachy","year":"2013","journal-title":"Haematologica"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/S1470-2045(15)00447-7","article-title":"Bendamustine plus rituximab versus fludarabine plus rituximab for patients with relapsed indolent and mantle-cell lymphomas: A multicentre, randomised, open-label, non-inferiority phase 3 trial","volume":"17","author":"Rummel","year":"2016","journal-title":"Lancet Oncol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"2944","DOI":"10.1182\/blood-2013-11-531327","article-title":"Randomized trial of bendamustine-rituximab or R-CHOP\/R-CVP in first-line treatment of indolent NHL or MCL: The BRIGHT study","volume":"123","author":"Flinn","year":"2014","journal-title":"Blood"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1200\/JCO.18.00605","article-title":"First-Line Treatment of Patients with Indolent Non-Hodgkin Lymphoma or Mantle-Cell Lymphoma with Bendamustine Plus Rituximab Versus R-CHOP or R-CVP: Results of the BRIGHT 5-Year Follow-Up Study","volume":"37","author":"Flinn","year":"2019","journal-title":"J. Clin. Oncol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"2815","DOI":"10.1200\/JCO.19.01073","article-title":"Sustained Progression-Free Survival Benefit of Rituximab Maintenance in Patients with Follicular Lymphoma: Long-Term Results of the PRIMA Study","volume":"37","author":"Bachy","year":"2019","journal-title":"J. Clin. Oncol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1056\/NEJMoa1614598","article-title":"Obinutuzumab for the First-Line Treatment of Follicular Lymphoma","volume":"377","author":"Marcus","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1056\/NEJMoa1805104","article-title":"Rituximab plus Lenalidomide in Advanced Untreated Follicular Lymphoma","volume":"379","author":"Morschhauser","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1200\/JCO.2005.12.052","article-title":"Rituximab therapy for patients with newly diagnosed, advanced-stage, follicular grade I non-Hodgkin\u2019s lymphoma: A phase II trial in the North Central Cancer Treatment Group","volume":"23","author":"Witzig","year":"2005","journal-title":"J. Clin. Oncol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"2395","DOI":"10.1200\/JCO.2017.76.8960","article-title":"Immunochemotherapy with Obinutuzumab or Rituximab for Previously Untreated Follicular Lymphoma in the GALLIUM Study: Influence of Chemotherapy on Efficacy and Safety","volume":"36","author":"Hiddemann","year":"2018","journal-title":"J. Clin. Oncol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1007\/s40273-018-0740-4","article-title":"Obinutuzumab in Combination with Chemotherapy for the First-Line Treatment of Patients with Advanced Follicular Lymphoma: An Evidence Review Group Evaluation of the NICE Single Technology Appraisal","volume":"37","author":"Thielen","year":"2019","journal-title":"Pharmacoeconomics"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"3239","DOI":"10.1200\/JCO.22.00843","article-title":"Six-Year Results From RELEVANCE: Lenalidomide Plus Rituximab (R2) Versus Rituximab-Chemotherapy Followed by Rituximab Maintenance in Untreated Advanced Follicular Lymphoma","volume":"40","author":"Morschhauser","year":"2022","journal-title":"J. Clin. Oncol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1111\/bjh.15720","article-title":"Maintenance rituximab or observation after frontline treatment with bendamustine-rituximab for follicular lymphoma","volume":"184","author":"Hill","year":"2019","journal-title":"Br. J. Haematol."},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Bastos-Oreiro, M., Gutierrez, A., Cabero, A., L\u00f3pez, J., Villafuerte, P., Jim\u00e9nez-Ubieto, A., de O\u00f1a, R., De la Fuente, A., Navarro, B., and Pe\u00f1alver, J. (2024). Comparing R-Bendamustine vs. R-CHOP Plus Maintenance Therapy as First-Line Systemic Treatment in Follicular Lymphoma: A Multicenter Retrospective GELTAMO Study. Cancers, 16.","DOI":"10.3390\/cancers16071285"},{"key":"ref_72","first-page":"CD007678","article-title":"High-dose therapy with autologous stem cell transplantation versus chemotherapy or immuno-chemotherapy for follicular lymphoma in adults","volume":"1","author":"Schaaf","year":"2012","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/j.canrad.2017.09.003","article-title":"Radiotherapy of relapse-refractory follicular lymphoma","volume":"22","author":"Grignano","year":"2018","journal-title":"Cancer Radiother."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1200\/JCO.19.00010","article-title":"AUGMENT: A Phase III Study of Lenalidomide Plus Rituximab Versus Placebo Plus Rituximab in Relapsed or Refractory Indolent Lymphoma","volume":"37","author":"Leonard","year":"2019","journal-title":"J. Clin. Oncol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"3295","DOI":"10.1182\/blood-2006-05-021113","article-title":"Rituximab maintenance improves clinical outcome of relapsed\/resistant follicular non-Hodgkin lymphoma in patients both with and without rituximab during induction: Results of a prospective randomized phase 3 intergroup trial","volume":"108","author":"Klasa","year":"2006","journal-title":"Blood"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1016\/S1470-2045(16)30097-3","article-title":"Obinutuzumab plus bendamustine versus bendamustine monotherapy in patients with rituximab-refractory indolent non-Hodgkin lymphoma (GADOLIN): A randomised, controlled, open-label, multicentre, phase 3 trial","volume":"17","author":"Sehn","year":"2016","journal-title":"Lancet Oncol."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1182\/blood-2022-158631","article-title":"Five-year results and overall survival update from the phase 3 randomized study AUGMENT: Lenalidomide plus rituximab (R-2) vs rituximab plus placebo in patients with relapsed\/refractory indolent Non-Hodgkin lymphoma","volume":"140","author":"Leonard","year":"2022","journal-title":"Blood"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"e429","DOI":"10.1016\/S2352-3026(19)30089-4","article-title":"Obinutuzumab combined with lenalidomide for relapsed or refractory follicular B-cell lymphoma (GALEN): A multicentre, single-arm, phase 2 study","volume":"6","author":"Morschhauser","year":"2019","journal-title":"Lancet Haematol."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"5107","DOI":"10.1200\/JCO.23.00775","article-title":"ROSEWOOD: A Phase II Randomized Study of Zanubrutinib Plus Obinutuzumab Versus Obinutuzumab Monotherapy in Patients with Relapsed or Refractory Follicular Lymphoma","volume":"41","author":"Zinzani","year":"2023","journal-title":"J. Clin. Oncol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1111\/bjh.19951","article-title":"Acalabrutinib in combination with rituximab and lenalidomide in patients with relapsed or refractory follicular lymphoma: Results of the phase 1b open-label study (ACE-LY-003)","volume":"206","author":"Strati","year":"2025","journal-title":"Br. J. Haematol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/S0140-6736(25)01778-7","article-title":"Tafasitamab, lenalidomide, and rituximab in relapsed or refractory follicular lymphoma (inMIND): A global, phase 3, randomised controlled trial","volume":"407","author":"Sehn","year":"2026","journal-title":"Lancet"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"e23","DOI":"10.1016\/S2352-3026(24)00345-4","article-title":"Loncastuximab tesirine with rituximab in patients with relapsed or refractory follicular lymphoma: A single-centre, single-arm, phase 2 trial","volume":"12","author":"Alderuccio","year":"2025","journal-title":"Lancet Haematol."},{"key":"ref_83","first-page":"1194","article-title":"Polatuzumab vedotin plus bendamustine and rituximab or obinutuzumab in relapsed\/refractory follicular lymphoma: A phase Ib\/II study","volume":"109","author":"Flowers","year":"2024","journal-title":"Haematologica"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"1433","DOI":"10.1016\/S1470-2045(20)30441-1","article-title":"Tazemetostat for patients with relapsed or refractory follicular lymphoma: An open-label, single-arm, multicentre, phase 2 trial","volume":"21","author":"Morschhauser","year":"2020","journal-title":"Lancet Oncol."},{"key":"ref_85","first-page":"820","article-title":"A closer look at tazemetostat","volume":"18","author":"Batlevi","year":"2020","journal-title":"Clin. Adv. Hematol. Oncol."},{"key":"ref_86","first-page":"e1","article-title":"Real-World Evidence of Axicabtagene Ciloleucel for the Treatment of Large B Cell Lymphoma in the United States","volume":"28","author":"Jacobson","year":"2022","journal-title":"Transplant. Cell Ther."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1182\/blood.2023021243","article-title":"Three-year follow-up analysis of axicabtagene ciloleucel in relapsed\/refractory indolent non-Hodgkin lymphoma (ZUMA-5)","volume":"143","author":"Neelapu","year":"2024","journal-title":"Blood"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1038\/s41591-021-01622-0","article-title":"Tisagenlecleucel in adult relapsed or refractory follicular lymphoma: The phase 2 ELARA trial","volume":"28","author":"Fowler","year":"2022","journal-title":"Nat. Med."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"1713","DOI":"10.1182\/blood.2023021567","article-title":"Durable response after tisagenlecleucel in adults with relapsed\/refractory follicular lymphoma: ELARA trial update","volume":"143","author":"Dreyling","year":"2024","journal-title":"Blood"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"2199","DOI":"10.1038\/s41591-024-02986-9","article-title":"Lisocabtagene maraleucel in follicular lymphoma: The phase 2 TRANSCEND FL study","volume":"30","author":"Morshchhauser","year":"2024","journal-title":"Nat. Med."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1016\/S1470-2045(22)00335-7","article-title":"Safety and efficacy of mosunetuzumab, a bispecific antibody, in patients with relapsed or refractory follicular lymphoma: A single-arm, multicentre, phase 2 study","volume":"23","author":"Budde","year":"2022","journal-title":"Lancet Oncol."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1182\/blood.2024025454","article-title":"Long-term 3-year follow-up of mosunetuzumab in relapsed or refractory follicular lymphoma after \u22652 prior therapies","volume":"145","author":"Sehn","year":"2025","journal-title":"Blood"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"e593","DOI":"10.1016\/S2352-3026(24)00166-2","article-title":"Epcoritamab monotherapy in patients with relapsed or refractory follicular lymphoma (EPCORE NHL-1): A phase 2 cohort of a single-arm, multicentre study","volume":"11","author":"Linton","year":"2024","journal-title":"Lancet Haematol."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1016\/j.annonc.2024.08.2239","article-title":"Safety and efficacy of odronextamab in patients with relapsed or refractory follicular lymphoma","volume":"35","author":"Kim","year":"2024","journal-title":"Ann. Oncol."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/S0140-6736(25)02360-8","article-title":"Epcoritamab, lenalidomide, and rituximab versus lenalidomide and rituximab for relapsed or refractory follicular lymphoma (EPCORE FL-1): A global, open-label, randomised, phase 3 trial","volume":"407","author":"Falchi","year":"2026","journal-title":"Lancet"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"2853","DOI":"10.1200\/JCO.2009.26.5827","article-title":"Rituximab maintenance treatment of relapsed\/resistant follicular non-Hodgkin\u2019s lymphoma: Long-term outcome of the EORTC 20981 phase III randomized intergroup study","volume":"28","author":"Giurgea","year":"2010","journal-title":"J. Clin. Oncol."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"6955","DOI":"10.1002\/cam4.2555","article-title":"Response-adapted treatment with rituximab, bendamustine, mitoxantrone, and dexamethasone followed by rituximab maintenance in patients with relapsed or refractory follicular lymphoma after first-line immunochemotherapy: Results of the RBMDGELTAMO08 phase II trial","volume":"8","author":"Giraldo","year":"2019","journal-title":"Cancer Med."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1200\/JCO.23.01097","article-title":"Recent Bendamustine Treatment Before Apheresis Has a Negative Impact on Outcomes in Patients with Large B-Cell Lymphoma Receiving Chimeric Antigen Receptor T-Cell Therapy","volume":"42","author":"Iacoboni","year":"2024","journal-title":"J. Clin. Oncol."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.1016\/j.bbmt.2018.03.022","article-title":"Autologous Stem Cell Transplantation for Patients with Early Progression of Follicular Lymphoma: A Follow-Up Study of 2 Randomized Trials from the German Low Grade Lymphoma Study Group","volume":"24","author":"Jurinovic","year":"2018","journal-title":"Biol. Blood Marrow Transplant."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.1016\/j.bbmt.2017.12.771","article-title":"Autologous Transplantation in Follicular Lymphoma with Early Therapy Failure: A National LymphoCare Study and Center for International Blood and Marrow Transplant Research Analysis","volume":"24","author":"Casulo","year":"2018","journal-title":"Biol. Blood Marrow Transplant."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"1631","DOI":"10.1016\/j.bbmt.2017.05.021","article-title":"Autologous Stem Cell Transplantation for Follicular Lymphoma: Favorable Long-Term Survival Irrespective of Pretransplantation Rituximab Exposure","volume":"23","author":"Grande","year":"2017","journal-title":"Biol Blood Marrow Transplant."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1002\/hon.2553","article-title":"Autologous stem cell transplantation may be curative for patients with follicular lymphoma with early therapy failure who reach complete response after rescue treatment","volume":"36","author":"Grande","year":"2018","journal-title":"Hematol. Oncol."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1097\/01.HS9.0000847492.88194.df","article-title":"P1156: MAGNIFY phase 3B study of lenalidomide + rituximab (R2) followed by maintenance in relapsed\/refractory indolent non-Hodgkin lymphoma: Complete induction phase analysis","volume":"6","author":"Lansigan","year":"2022","journal-title":"Hemasphere"},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"2250","DOI":"10.1200\/JCO.23.02329","article-title":"Durable Responses with Mosunetuzumab in Relapsed\/Refractory Indolent and Aggressive B-Cell Non-Hodgkin Lymphomas: Extended Follow-Up of a Phase I\/II Study","volume":"42","author":"Budde","year":"2024","journal-title":"J. Clin. Oncol."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1182\/blood-2023-173692","article-title":"Mosunetuzumab Monotherapy Continues to Demonstrate Durable Responses in Patients with Relapsed and\/or Refractory Follicular Lymphoma after \u22652 Prior Therapies: 3-Year Follow-up from a Pivotal Phase II Study","volume":"142","author":"Schuster","year":"2023","journal-title":"Blood"},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1182\/blood.2024025699","article-title":"Building the future management of follicular lymphoma with T-cell-redirecting strategies","volume":"145","author":"Iacoboni","year":"2025","journal-title":"Blood"},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"677","DOI":"10.18632\/oncotarget.28229","article-title":"Tazemetostat in relapsed\/refractory follicular lymphoma: A propensity score-matched analysis of E7438-G000-101 trial outcomes","volume":"13","author":"Proudman","year":"2022","journal-title":"Oncotarget"},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"2296","DOI":"10.1182\/blood-2022-166991","article-title":"Tazemetostat in Combination with Lenalidomide and Rituximab in Patients with Relapsed\/Refractory Follicular Lymphoma: Phase 1b Results of Symphony-1","volume":"140","author":"Batlevi","year":"2022","journal-title":"Blood"},{"key":"ref_109","doi-asserted-by":"crossref","unstructured":"Mart\u00ednez-Laperche, C.C., Sanz-Villanueva, L., D\u00edaz Crespo, F.J., Mu\u00f1iz, P., Mart\u00edn Rojas, R., Carbonell, D., Chicano, M., Su\u00e1rez-Gonz\u00e1lez, J., Men\u00e1rguez, J., and Kwon, M. (2022). EZH2 mutations at diagnosis in follicular lymphoma: A promising biomarker to guide frontline treatment. BMC Cancer., 22.","DOI":"10.1186\/s12885-022-10335-7"},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"2541","DOI":"10.1002\/cncr.31374","article-title":"Autologous transplantation versus allogeneic transplantation in patients with follicular lymphoma experiencing early treatment failure","volume":"124","author":"Smith","year":"2018","journal-title":"Cancer"},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"1812","DOI":"10.1182\/blood.2024026016","article-title":"An updated understanding of follicular lymphoma transformation","volume":"146","author":"Parry","year":"2025","journal-title":"Blood"},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1056\/NEJMoa2115304","article-title":"Polatuzumab vedotin in previously untreated diffuse large B-cell lymphoma","volume":"386","author":"Tilly","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_113","first-page":"559","article-title":"Consensus document of the Spanish Association for Study of the Liver on the treatment of hepatitis B virus infection","volume":"43","author":"Rodriguez","year":"2020","journal-title":"Gastroenterol. Hepatol."}],"updated-by":[{"DOI":"10.3390\/cancers18121950","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T00:00:00Z","timestamp":1769472000000}}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/3\/395\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T09:51:50Z","timestamp":1781603510000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/3\/395"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,27]]},"references-count":113,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["cancers18030395"],"URL":"https:\/\/doi.org\/10.3390\/cancers18030395","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,27]]}}}