By: Dr Joanne Lee (Published in Lianhe Zaobao, 9 September 2025)
Follicular lymphoma (FL) is a slow-growing, chronic form of non-Hodgkin lymphoma that usually progresses gradually over many years. Many patients can remain in good health for long periods without needing immediate treatment. In Singapore, about 800 new lymphoma cases are diagnosed each year, of which approximately 20% are follicular lymphoma. The disease typically affects adults over 50 years old.
Understanding the Disease
FL arises from B lymphocytes, a type of white blood cell that forms part of the immune system. It is often discovered incidentally — for example, when patients notice persistent lymph node swelling in the neck, armpits, abdomen, or groin. Some experience fatigue, night sweats, or weight loss, while others remain completely asymptomatic.
“Watchful Waiting” — Not All Cases Need Immediate Therapy
Unlike aggressive lymphomas that require urgent chemotherapy, FL can often be safely managed with a strategy called “watchful waiting” or “active surveillance.” If the patient feels well and organ function is unaffected, doctors may recommend regular monitoring and imaging rather than immediate treatment.
When Treatment Is Needed
Treatment becomes necessary when symptoms develop — such as bulky or enlarging lymph nodes, compression of nearby organs, or systemic “B symptoms” (fever, night sweats, weight loss).
Available options include targeted monoclonal antibodies, chemotherapy, and newer therapies such as bispecific antibodies and CAR-T cell therapy, which have transformed long-term outcomes.
Living Well with Follicular Lymphoma
With modern treatments, most patients live for many years with good quality of life, even if relapses occur. Follicular lymphoma today is considered a manageable, chronic condition rather than an immediately life-threatening cancer.
