The clinical dilemma of grade 3 follicular lymphoma

The recommended treatment of grade 3 (or grade 3B) follicular lymphoma patients is that of diffuse large B-cell lymphoma rather than that of follicular lymphoma. These recommendations are not supported by randomized evidence. While RCHOP is a good therapeutic option for both follicular lymphoma and diffuse large B-cell lymphoma, the advent of targeted therapies is likely to change the optimal first-line regimen in both of these entities or, at least, some subset of patients. If that becomes the case, the current consensus-based (rather than evidence-based) approach to grade 3 follicular lymphoma will become a clinical concern to which we are, at present, unable to provide a satisfactory solution.