American Board of Internal Medicine (ABIM) Certification Practice Exam

What treatment is effective for localized symptoms of follicular lymphoma?

1. Systemic chemotherapy

2. Involved-field radiation therapy combined with rituximab

3. High-dose corticosteroids

4. Stem cell transplant

The correct answer is: Involved-field radiation therapy combined with rituximab

Involved-field radiation therapy combined with rituximab is particularly effective for localized symptoms of follicular lymphoma because follicular lymphoma is a type of non-Hodgkin lymphoma that is often slow-growing and can initially present with localized disease. This treatment approach leverages the localized application of radiation to target the lymphoma-affected areas, thereby effectively reducing tumor burden and alleviating symptoms such as pain or swelling associated with the lymphoma. The addition of rituximab, a monoclonal antibody that targets CD20 on B cells, enhances the effectiveness of the treatment by promoting tumor cell destruction and reducing the chance of recurrence. This combined modality is recognized for providing both immediate symptom relief and long-term disease control in cases where the lymphoma is limited to a specific region rather than being widely disseminated throughout the body. Other treatment options, such as systemic chemotherapy, are generally reserved for more advanced cases of follicular lymphoma, as they can have broader systemic effects and are associated with more significant side effects. High-dose corticosteroids may provide temporary relief of symptoms but do not target the underlying lymphoma effectively. Stem cell transplant is typically considered for relapsed or refractory cases and is not indicated for localized symptoms, as it is an intensive procedure aimed at more widespread disease