This is a living document. I will update it as my treatment continues.
If you have just been diagnosed with Follicular Lymphoma — or if you are somewhere in the middle of this, like me — I hope this gives you a clearer picture of what one patient's journey can look like.
The Diagnosis
February 2021.
Stage 4 Follicular Lymphoma, Grade 3A, with bone marrow involvement.
A few things worth explaining for those who are new to this diagnosis:
Grade 3A sits at the boundary between indolent (slow-growing) and aggressive lymphoma. Unlike Grade 1 or 2, which are typically managed conservatively, Grade 3A is usually treated more aggressively — similar to Diffuse Large B-Cell Lymphoma (DLBCL). This is why my first treatment was R-CHOP rather than a gentler regimen.
Stage 4 means the disease had spread beyond the lymph nodes to other organs. In my case, the bone marrow was involved — confirmed by bone marrow biopsy at diagnosis.
First-Line Treatment: R-CHOP
February 2021 — June 2021
6 cycles of R-CHOP
R-CHOP is a combination chemotherapy regimen:
- R — Rituximab (anti-CD20 monoclonal antibody)
- C — Cyclophosphamide
- H — Doxorubicin (Hydroxydaunorubicin)
- O — Vincristine (Oncovin)
- P — Prednisone
6 cycles over approximately 4 months. Standard first-line treatment for Grade 3A Follicular Lymphoma.
Outcome: Complete remission.
Maintenance Therapy: Rituximab
July 2021 — March 2023
Rituximab monotherapy, every 2 months × 12 cycles
After achieving complete remission, I moved into maintenance therapy. Rituximab alone, administered every two months for two years.
The goal of maintenance is to keep the disease from returning. For two years, it worked.
First Relapse
May 2023.
Two years after complete remission, the lymphoma came back.
Follicular Lymphoma is known for its pattern of remission and relapse. For Grade 3A patients especially, relapse is not uncommon. That knowledge does not make it easier to hear.
Second-Line Treatment: Obinutuzumab + Bendamustine
June 2023 — November 2023
6 cycles of Obinutuzumab (Gazyva) + Bendamustine
Second-line treatment for relapsed Follicular Lymphoma. Obinutuzumab is a next-generation anti-CD20 antibody — more potent than Rituximab in its immune cell-killing mechanism.
Outcome: Partial remission. MRD positive.
Complete remission was not achieved. Minimal residual disease (MRD) remained detectable, meaning microscopic cancer cells were still present after treatment.
Maintenance Therapy: Obinutuzumab
January 2024 — September 2025
Obinutuzumab monotherapy, every 2 months
Maintenance continued with Obinutuzumab alone. Nearly two years of treatment every two months.
Second Relapse
October 2025.
Confirmed on PET-CT scan. Bone marrow biopsy was not performed at this point.
Second relapse after second-line treatment is sometimes referred to as double-refractory or multiply relapsed Follicular Lymphoma. Treatment options narrow with each relapse, and the decisions become more complex.
Where I Am Now
Next planned treatment: Mosunetuzumab (Lunsumio)
Mosunetuzumab is a bispecific antibody — a CD20×CD3 T-cell engaging therapy. It works differently from traditional chemotherapy or anti-CD20 antibodies. Rather than directly killing cancer cells, it recruits the body's own T cells to do the work.
It was approved by the FDA in December 2022 for relapsed or refractory Follicular Lymphoma after two or more lines of therapy — and updated to subcutaneous formulation approval in December 2025.
I have not started treatment yet. That is a longer story, and I will write about it separately.
In the meantime, I am managing my health through a low-carb, high-fat (LCHF) diet, regular walking, and continuing to follow the research closely.
My approach to diet is realistic rather than rigid. On most days at home, I follow LCHF closely. But I also have a life — occasional meals out with my parents, rice balls and fruit on hiking days, and the understanding that a longer fast the next morning can reset the balance. By the standards of a typical Korean diet, I eat very low carbohydrate. By strict ketogenic standards, I go over sometimes. I have made peace with that.
Still here. Still moving.
This post reflects my personal medical history and is not medical advice. Please consult your oncologist for treatment decisions.