Dr Kahl notes that a variety of evidence-based options are available for a patient with low tumor burden by GELF criteria, and his preference is to “watch and wait,” although he acknowledges that rituximab monotherapy or rituximab/chemotherapy are also considerations given the high FLIPI score. Both faculty members were co-chairs of the landmark RESORT study, which demonstrated prolonged responses with 4 courses of weekly rituximab monotherapy in most patients with low tumor-burden disease, and although the trial did not reveal a survival benefit with prolonging rituximab indefinitely, Dr Williams and many other oncologists now frequently turn to rituximab monotherapy for these patients with the hope of delaying disease progression and the need for chemotherapy.

Arcaini L et al. Correlation of the FLIPI score for follicular lymphoma with period of diagnosis and type of treatment. Leuk Res 2006;30(3):277-82. Abstract

Ardeshna KM et al. Rituximab versus a watch-and-wait approach in patients with advanced-stage, asymptomatic, non-bulky follicular lymphoma: An open-label randomised phase 3 trial. Lancet Oncol 2014;15(4):424-35. Abstract

Kahl BS et al. Rituximab extended schedule or re-treatment trial for low-tumor burden follicular lymphoma: Eastern cooperative oncology group protocol e4402. J Clin Oncol 2014;32(28):3096-102. Abstract