Hi , I am 49, Stage 4 , low grade nh follicular Lymphoma, with some bone marrow involvement. I recently completed 4...

Thank you for sharing your situation with me. I can hear the hope and concern in your message, and I want to help you understand what's happening with your treatment and what to expect moving forward.

Understanding Your Treatment So Far

You've completed rituximab monotherapy (Rituxan), which is an important first-line treatment for follicular lymphoma. According to the NCCN Guidelines for Follicular Lymphoma, rituximab is a CD20-targeting monoclonal antibody that works by binding to the CD20 protein found on B cells and causing them to die. This is exactly the kind of targeted approach you were hoping for to avoid chemotherapy.

What's Important to Know About Timing:

Response to rituximab typically takes time. Most patients don't see immediate shrinkage in nodes. Here's what the medical literature generally shows:

• Initial response phase: Weeks 2-8 after completing treatment is when you'd typically start to see changes
• Peak response: Many patients see their best response at 8-12 weeks after completing treatment
• Your PET scan in late June (about 3 months after your last infusion) is well-timed to assess your response

This means you're still in the early window—2 weeks out is actually quite early to expect significant node shrinkage.

What You Might Notice

According to NCCN guidelines, patients may experience:

• Gradual reduction in node size (not always dramatic or quick)
• Fatigue (common after rituximab)
• General sense of improvement as treatment takes effect
• Some nodes may take longer to shrink than others

Important Context About Your Situation

Stage 4 with bone marrow involvement means your disease is more extensive, but this doesn't change the fundamental approach—rituximab is still a standard first-line option. The NCCN Guidelines note that rituximab can be used as monotherapy or combined with other treatments depending on individual factors.

Questions to Ask Your Oncologist at Your Next Visit

Since you're monitoring that node under your left armpit, here are specific questions that will help you understand your progress:

1. "What size was that left axillary node at my last imaging, and what would you consider meaningful shrinkage?" (This gives you a baseline to track)

2. "Based on my bone marrow involvement, are you planning any additional monitoring between now and my June PET scan?" (Some patients get interim scans)

3. "If the June PET scan shows good response, what's the next phase of my treatment plan?" (Understanding the bigger picture helps with hope and planning)

4. "Are there any signs or symptoms I should watch for that would warrant earlier imaging?" (Empowers you to advocate for yourself)

5. "How do you define 'response' for my specific situation—complete response, partial response, or are we looking at stable disease as a win?" (Different patients have different goals)

A Reality Check on Timelines

I want to be honest: individual responses vary significantly. Some patients see nodes shrinking noticeably by 6-8 weeks; others take the full 12 weeks to show clear response. The fact that you're hoping to "get your life back" by June is understandable, but your oncologist will have the best sense of realistic timelines for your specific case.

About Bispecific Antibodies

You mentioned bispecific antibodies like epcoritamab (Epkinly) aren't available in the UK until third-line. According to NCCN Guidelines, bispecific antibodies like epcoritamab and mosunetuzumab (Lunsumio) are newer options that bind to both CD20 and CD3, engaging T cells to fight the lymphoma. The fact that you're starting with rituximab monotherapy first is a standard, evidence-based approach—and if it works, you may not need those later options.

What I Can't Do

I can't tell you:

• When your nodes will shrink (that depends on your individual biology)
• What your June PET scan will show
• Whether rituximab alone will be sufficient long-term for your case

These are conversations for your oncologist, who knows your complete medical picture.

Moving Forward

This is educational information only. Always consult your healthcare team for personalized medical advice and decisions.

Your June PET scan will give you and your team real data to work with. In the meantime, staying in close communication with your oncology team and noting any changes you observe is exactly the right approach.

Is there anything specific about how rituximab works, or other aspects of your treatment plan, that I can help clarify?