American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the standard multiagent therapy for symptomatic systemic follicular lymphoma?

1. Rituximab and bendamustine

2. Rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisone

3. Single-agent chemotherapy

4. Rituximab with gemcitabine

The correct answer is: Rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisone

The standard multiagent therapy for symptomatic systemic follicular lymphoma is indeed the combination of rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisone (commonly referred to as R-CHOP). This regimen is effective for treating not only follicular lymphoma but also various types of aggressive lymphomas. Rituximab, a monoclonal antibody targeting CD20, has been shown to significantly enhance the efficacy of chemotherapy by specifically targeting B-cells, which are often implicated in lymphoma. When combined with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone), this regimen improves overall survival and response rates compared to chemotherapy alone. While other combinations and therapies might be suitable for certain conditions or patient circumstances, R-CHOP remains the backbone treatment for symptomatic patients with follicular lymphoma. It's important to tailor therapy based on individual patient factors, disease aggressiveness, and prior treatments, but R-CHOP has a strong foundation supported by clinical evidence. In contrast, therapies such as single-agent chemotherapy or combinations with agents like gemcitabine tend to be less effective as initial treatments for symptomatic follicular lymphoma. While alternatives exist, they do not provide the same