1
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Jeong SH. Treatment of indolent lymphoma. Blood Res 2022; 57:120-129. [PMID: 35483936 PMCID: PMC9057664 DOI: 10.5045/br.2022.2022054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/08/2022] [Accepted: 04/21/2022] [Indexed: 11/18/2022] Open
Abstract
Treatment of indolent lymphoma has improved significantly in recent decades since the advent of rituximab (anti-CD20 monoclonal antibody). Although, some patients with limited disease can be cured with radiation therapy alone, most patients experience disease progression and recurrence during follow-up despite early initiation of treatment. Thus, watch-and-wait is still regarded the standard for asymptomatic patients. Patients with indolent lymphoma have a significant heterogeneity in terms of tumor burden, symptoms (according to anatomical sites) and the need for instant therapy. Therefore, the initiation of treatment and treatment option should be decided with a clear goal in each patient according to the need for therapy and clinical benefits with the chosen treatment. In this review, we cover the current treatment of follicular lymphoma and marginal zone lymphoma.
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Affiliation(s)
- Seong Hyun Jeong
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea
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2
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Cartron G, Trotman J. Time for an individualized approach to first-line management of follicular lymphoma. Haematologica 2022; 107:7-18. [PMID: 34985230 PMCID: PMC8719078 DOI: 10.3324/haematol.2021.278766] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Indexed: 01/12/2023] Open
Abstract
Follicular lymphoma is a heterogeneous B-cell lymphoma both in presentation and at progression. For most patients it is a chronic, relapsing indolent disease with overall survival expectations now potentially beyond 20 years. However, in a significant minority (~20%) who experience early progression or histological transformation after treatment, the disease no longer has an indolent behavior. This review looks at the development of prognostic indices, staging and therapies for follicular lymphoma, identifying where the data can, and cannot, guide the multidisciplinary team to determine an individualized approach to first-line therapy. A nuanced patient- and disease-specific approach is necessary to maximize disease response and survival while minimizing therapeutic toxicity.
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Affiliation(s)
| | - Judith Trotman
- Department of Hematology, Concord Hospital, Sydney, Australia
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3
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Abstract
Follicular lymphoma (FL) is a heterogeneous disease with varying prognosis owing to differences in clinical, laboratory, and disease parameters. Although generally considered incurable, prognosis for early and advanced stage disease has improved because of therapeutic advances, several of which have resulted from elucidation of the biologic and molecular basis of the disease. The choice of treatment for FL is highly dependent on patient and disease characteristics. Several tools are available for risk stratification, although limitations in their routine clinical use exist. For limited disease, treatment options include radiotherapy, rituximab monotherapy or combination regimens, and surveillance. Treatment of advanced disease is often determined by tumor burden, with surveillance or rituximab considered for low tumor burden and chemoimmunotherapy for high tumor burden disease. Treatment for relapsed or refractory disease is influenced by initial first-line therapy and the duration and quality of the response. At present, there is no consensus for treatment of patients with early or multiply-relapsed disease; however, numerous agents, combination regimens, and transplant options have demonstrated efficacy. While the number of therapies available to treat FL has increased together with an improved understanding of the underlying biologic basis of disease, the best approach to select the most appropriate treatment strategy for an individual patient at a particular time continues to be elucidated. This chapter considers prognostic factors and the evolving treatment landscape of FL, including recent and emerging therapies, as well as remaining unmet needs.
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4
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Lumish M, Falchi L, Imber BS, Scordo M, von Keudell G, Joffe E. How we treat mature B-cell neoplasms (indolent B-cell lymphomas). J Hematol Oncol 2021; 14:5. [PMID: 33407745 PMCID: PMC7789477 DOI: 10.1186/s13045-020-01018-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/02/2020] [Indexed: 12/30/2022] Open
Abstract
Mature B cell neoplasms, previously indolent non-Hodgkin lymphomas (iNHLs), are a heterogeneous group of malignancies sharing similar disease courses and treatment paradigms. Most patients with iNHL have an excellent prognosis, and in many, treatment can be deferred for years. However, some patients will have an accelerated course and may experience transformation into aggressive lymphomas. In this review, we focus on management concepts shared across iNHLs, as well as histology-specific strategies. We address open questions in the field, including the influence of genomics and molecular pathway alterations on treatment decisions. In addition, we review the management of uncommon clinical entities including nodular lymphocyte-predominant Hodgkin lymphoma, hairy cell leukemia, splenic lymphoma and primary lymphoma of extranodal sites. Finally, we include a perspective on novel targeted therapies, antibodies, antibody-drug conjugates, bispecific T cell engagers and chimeric antigen receptor T cell therapy.
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Affiliation(s)
- Melissa Lumish
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, SR-441B, New York, NY, 10065, USA
| | - Lorenzo Falchi
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, SR-441B, New York, NY, 10065, USA
| | - Brandon S Imber
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, SR-441B, New York, NY, 10065, USA
| | - Michael Scordo
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, SR-441B, New York, NY, 10065, USA
| | - Gottfried von Keudell
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, SR-441B, New York, NY, 10065, USA
| | - Erel Joffe
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, SR-441B, New York, NY, 10065, USA.
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5
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Cencini E, Fabbri A, Mecacci B, Bocchia M. How to manage early-stage follicular lymphoma. Expert Rev Hematol 2020; 13:1093-1105. [PMID: 32869685 DOI: 10.1080/17474086.2020.1818226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Early-stage follicular lymphoma (FL) is characterized by good prognosis and can be cured with involved-field radiotherapy (IF-RT) in most cases. PET scan is a milestone of diagnostic work-up, with the aim of identifying a truly localized disease; however, staging in most of the studies was without PET. AREAS COVERED We have searched in MEDLINE (inclusive dates 1994-2020) data about localized FL management. While high-quality evidence is lacking, current guidelines recommend IFRT or involved-site RT as first-line treatment in limited stages FL. Since a significant proportion of disease relapse occurred in non-irradiated areas, it has been hypothesized that occult disease could be present at diagnosis and could persist after RT, contributing to relapse. Available treatment options include watch-and-wait, chemotherapy, RT plus chemo- or chemo-immunotherapy, and RT combined with rituximab (R). EXPERT OPINION RT combined with chemotherapy could increase PFS, but a clear OS benefit is lacking and toxic effects could be unacceptable. A promising strategy is represented by R combined with IF-RT, with low relapse rate outside the radiation fields and without the toxicity reported with chemotherapy. The study of prognostic factors in PET-staged patients, the reduction of RT fields and doses, and a response-adapted strategy represent new perspectives to investigate.
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Affiliation(s)
- Emanuele Cencini
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese & University of Siena , Siena, Italy
| | - Alberto Fabbri
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese & University of Siena , Siena, Italy
| | - Bianca Mecacci
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese & University of Siena , Siena, Italy
| | - Monica Bocchia
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese & University of Siena , Siena, Italy
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6
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Patient-level Factors Associated With the Initial Management of Older Adults Diagnosed With Follicular Lymphoma: A Surveillance, Epidemiology, and End Results-Medicare Analysis. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 20:e184-e194. [PMID: 31956071 DOI: 10.1016/j.clml.2019.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 12/03/2019] [Accepted: 12/14/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION We evaluated patient-level factors associated with the initial management of older adults diagnosed with follicular lymphoma (FL). MATERIALS AND METHODS Using linked Surveillance, Epidemiology, and End Results-Medicare (SEER-Medicare) data; we identified 11,500 beneficiaries aged ≥ 66 years, diagnosed with FL between 2000 and 2013. A logistic regression model was used to estimate adjusted odds ratios (AORs) for factors associated with the receipt of active treatment versus watchful waiting (WW) as an initial management strategy. A multinomial logistic regression model was used to predict factors associated with receipt of specific active treatments, namely chemoimmunotherapy, rituximab monotherapy, chemotherapy, or radiation as compared with WW. RESULTS Overall, the initial management strategies adopted were WW (49%), chemoimmunotherapy (25%), radiation (10%), rituximab monotherapy (9%), and chemotherapy (7%). In reference to WW, grade III FL (AOR, 2.21; 95% confidence interval [CI], 1.99-2.46), increasing disease stage (Stage IV AOR, 1.80; 95% CI, 1.62-2.00), and use of preventive services (AOR, 1.18; 95% CI, 1.07-1.30) were associated with increased odds of active treatment receipt. Age > 80 years (AOR, 0.79; 95% CI, 0.71-0.87), Non-Hispanic African-American race (AOR, 0.64; 95% CI, 0.50-0.80), and state buy-in coverage (AOR, 0.81; 95% CI, 0.70-0.94) were associated with decreased odds of active treatment receipt. In reference to WW, the multinomial logistic regression model displayed differences in the receipt of rituximab-based therapies by age and comorbidity burden. Non-Hispanic African-American race and state buy-in coverage were associated with decreased odds of receiving rituximab-based therapies. CONCLUSION The present analysis identifies disparities in the initial management of older adults with FL owing to race and socioeconomic status. Future research should examine implications for subsequent treatment and health outcomes.
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Tobin JWD, Rule G, Colvin K, Calvente L, Hodgson D, Bell S, Dunduru C, Gallo J, Tsang ES, Tan X, Wong J, Pearce J, Campbell R, Tneh S, Shorten S, Ng M, Cochrane T, Tam CS, Abro E, Hawkes E, Hodges G, Kansara R, Talaulikar D, Gilbertson M, Johnston AM, Savage KJ, Villa D, Morris K, Ratnasingam S, Janowski W, Kridel R, Cheah CY, MacManus M, Matigian N, Mollee P, Gandhi MK, Hapgood G. Outcomes of stage I/II follicular lymphoma in the PET era: an international study from the Australian Lymphoma Alliance. Blood Adv 2019; 3:2804-2811. [PMID: 31570492 PMCID: PMC6784528 DOI: 10.1182/bloodadvances.2019000458] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 07/04/2019] [Indexed: 01/17/2023] Open
Abstract
Management practices in early-stage (I/II) follicular lymphoma (FL) are variable and include radiation (RT), systemic therapy, or combined modality therapy (CMT). There is a paucity of data regarding maintenance rituximab in this cohort. We conducted an international retrospective study of patients with newly diagnosed early-stage FL staged with positron emission tomography (PET)-computed tomography and bone marrow biopsy. Three hundred sixty-five patients (stage I, n = 221), median age 63 years, treated from 2005-2017 were included, with a median follow-up of 45 months. Management included watchful waiting (WW; n = 85) and active treatment (n = 280). The latter consisted of RT alone (n = 171) or systemic therapy (immunochemotherapy [n = 63] or CMT [n = 46]). Forty-nine systemically treated patients received maintenance rituximab; 72.7% of stage I patients received RT alone, compared to 42.6% with stage II (P < .001). Active therapies yielded comparable overall response rates (P = .87). RT alone and systemic therapy without maintenance rituximab yielded similar progression-free survival (PFS) (hazard ratio [HR], 1.32; 95% confidence interval [CI], 0.77-2.34; P = .96). Maintenance rituximab improved PFS (HR, 0.24; 95% CI, 0.095-0.64; P = .017). The incidence of transformation was lower with systemic therapy compared to RT or WW (HR, 0.20; 95% CI, 0.070-0.61; P = .034). Overall survival was similar among all practices, including WW (P = .40). In the largest comparative assessment of management practices in the modern era, variable practices each resulted in similar excellent outcomes. Randomized studies are required to determine the optimal treatment in early-stage FL.
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Affiliation(s)
- Joshua W D Tobin
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Gabrielle Rule
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Katherine Colvin
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Lourdes Calvente
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - David Hodgson
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Stephen Bell
- Department of Haematology, Calvary Mater Health, Newcastle, NSW, Australia
| | - Chengetai Dunduru
- Department of Haematology, Andrew Love Cancer Centre, University Hospital Geelong, Geelong, VIC, Australia
| | - James Gallo
- Department of Haematology, Royal Brisbane Hospital, Brisbane, QLD, Australia
| | - Erica S Tsang
- Division of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Xuan Tan
- Department of Haematology, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Jonathan Wong
- Department of Clinical Haematology, Monash Health, Melbourne, Victoria, Australia
| | - Jessica Pearce
- Department of Haematology, Townsville Hospital, Townsville, QLD, Australia
| | - Robert Campbell
- Department of Oncology and Clinical Haematology, Austin Hospital, Melbourne, VIC, Australia
| | - Shao Tneh
- Department of Haematology, Mater Hospital Brisbane, Brisbane, QLD, Australia
| | - Sophie Shorten
- Department of Haematology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Melissa Ng
- Department of Haematology, Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Tara Cochrane
- Department of Haematology, Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Constantine S Tam
- Department of Haematology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Emad Abro
- Department of Haematology, Mater Hospital Brisbane, Brisbane, QLD, Australia
| | - Eliza Hawkes
- Department of Oncology and Clinical Haematology, Austin Hospital, Melbourne, VIC, Australia
| | - Georgina Hodges
- Department of Haematology, Townsville Hospital, Townsville, QLD, Australia
| | - Roopesh Kansara
- Section of Medical Oncology and Haematology, University of Manitoba, Winnipeg, MB, Canada
| | - Dipti Talaulikar
- Department of Haematology, Canberra Hospital, Canberra, ACT, Australia
| | - Michael Gilbertson
- Department of Clinical Haematology, Monash Health, Melbourne, Victoria, Australia
| | - Anna M Johnston
- Department of Haematology, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Kerry J Savage
- Division of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Diego Villa
- Division of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Kirk Morris
- Department of Haematology, Royal Brisbane Hospital, Brisbane, QLD, Australia
| | - Sumi Ratnasingam
- Department of Haematology, Andrew Love Cancer Centre, University Hospital Geelong, Geelong, VIC, Australia
| | - Wojt Janowski
- Department of Haematology, Calvary Mater Health, Newcastle, NSW, Australia
| | - Robert Kridel
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Chan Y Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | | | - Nicholas Matigian
- QFAB Bioinformatics, Institute for Molecular Bioscience, University of Queensland, Brisbane, QLD, Australia
| | - Peter Mollee
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Maher K Gandhi
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Greg Hapgood
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
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8
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Andraos TY, Ayoub Z, Nastoupil LJ, Milgrom SA, Pinnix CC, Ng SP, Gunther JR, Fowler NH, Neelapu SS, Samaniego F, Fayad LE, Dabaja BS. Additional therapy improves outcomes in completely resected, limited-stage follicular lymphoma. Leuk Lymphoma 2019; 60:3258-3265. [PMID: 31234671 DOI: 10.1080/10428194.2019.1627535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Patients with early-stage nodal follicular lymphoma (FL) may be rendered free of detectable disease by a diagnostic excisional biopsy. We reviewed the management and outcomes of 48 patients with FL, diagnosed from 2003-2013, treated at a single institution. The primary endpoints were local control (LC) and progression-free survival (PFS).Median age at diagnosis was 54.5 years (range 15-74 years). Forty-seven patients were stage I (97.9%); 15 patients (31.3%) had grade 3 disease. Initial management consisted of observation (12 patients; 25.0%), radiation therapy (RT) alone (12 patients; 25.0%), systemic therapy alone (9 cases; 18.8%), or both (15 patients; 31.3%). Median follow-up was 4.92 years (range 0.5-13.83 years). 4-year PFS and OS were 80.9% and 97.1%, respectively. Patients treated with additional therapy experienced significantly better 4-year LC (100% vs. 81.8%; p = .012) and 4-year PFS (86.7% vs. 63.6%; p = .006).Patients with completely resected limited-stage FL would benefit from therapy beyond excisional biopsy alone.
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Affiliation(s)
- Therese Y Andraos
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zeina Ayoub
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Loretta J Nastoupil
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Lymphoma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sarah A Milgrom
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chelsea C Pinnix
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sweet Ping Ng
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jillian R Gunther
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nathan H Fowler
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Lymphoma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sattva S Neelapu
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Lymphoma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Felipe Samaniego
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Lymphoma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Luis E Fayad
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Lymphoma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bouthaina S Dabaja
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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9
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Sorigue M, Tuset V, Sancho JM. Treatment of localized-stage follicular lymphoma. Eur J Haematol 2018; 101:245-256. [PMID: 29754401 DOI: 10.1111/ejh.13093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2018] [Indexed: 12/15/2022]
Abstract
Follicular lymphoma (FL) is the most common indolent lymphoma, and it most frequently presents in an advanced stage. Therapeutic considerations for advanced stage are different from those of localized-stage FL, in which radiotherapy (RT) is generally recommended. However, the available evidence suffers from shortcomings that are relatively specific to this clinical entity due to its rarity and long survival with all available treatment modalities, including that most of the existing evidence originated at a time when diagnostic classifications, staging procedures and radiotherapeutic standards were different from those available today and when anti-CD20 monoclonal antibodies were not available. Available treatment modalities include observation, systemic therapy only, RT only and RT in combination with systemic therapy. We review the evidence available with each of them and the data from present-day clinical practice studies as well as briefly discuss what diagnostic and therapeutic developments may take place in the next few years.
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Affiliation(s)
- Marc Sorigue
- Department of Hematology, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Victòria Tuset
- Department of Radiation Oncology, ICO Badalona, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Juan-Manuel Sancho
- Department of Hematology, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Spain
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10
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Yokohama A, Hashimoto Y, Takizawa M, Shimizu H, Miyazawa Y, Saitoh A, Toyama K, Ishizaki T, Mitsui T, Saitoh T, Murayama K, Matsumoto M, Sawamura M, Murakami H, Hirato J, Kojima M, Nojima Y, Handa H, Tsukamoto N. Clinical management and outcomes of completely resected stage I follicular lymphoma. J Clin Exp Hematop 2018; 58:10-16. [PMID: 29415976 DOI: 10.3960/jslrt.17031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Recent studies have revealed the clinical and biological features of stage I follicular lymphoma (FL), but information about patients with stage I FL who underwent total resection after tissue biopsy is limited. Among 305 FL patients diagnosed between 2001 and 2013, clinical stage I disease was observed in 36 patients. Of these, 18 patients underwent total resection after diagnostic tissue biopsy. We used 18F-fluorodeoxyglucose positron emission CT for staging assessment in 13 of 18 patients (72.2%). The median age was 56.5 years. Six patients (33.3%) were male. The soluble interleukin-2 receptor alpha concentration was significantly lower than in patients with residual disease. Among these 18 patients, 7 patients (38.9%) were treated with a "watch-and-wait" (WW) policy, 7 (38.9%) were treated with involved-field irradiation, and 4 (22.2%) received systemic chemotherapy. Patients with resected disease were treated with significantly different strategies from those with residual disease (p = 0.0026). Five patients experienced relapse during follow-up (median follow-up: 48.2 months). All relapses were distant from the primary site, irrespective of treatment strategy. Among all stage I patients, disease resection was not a significant factor for survival (p = 0.9294). Collectively, the choice of treatment strategy was significantly influenced by patient status. Resection status was not significantly associated with survival after several treatment strategies.
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Affiliation(s)
- Akihiko Yokohama
- Blood Transfusion Service, Gunma University Hospital, Faculty of Medicine, Gunma University, Maebashi, Gunma, Japan
| | - Yoko Hashimoto
- Department of Hematology, Gunma University Graduate School of Medicine
| | - Makiko Takizawa
- Department of Hematology, Gunma University Graduate School of Medicine
| | - Hiroaki Shimizu
- Department of Hematology, Gunma University Graduate School of Medicine
| | - Yuri Miyazawa
- Division of Hematology, National Hospital Organization Shibukawa Medical Center, Shibukawa, Gunma, Japan
| | - Akio Saitoh
- Department of Hematology, Fujioka General Hospital, Fujioka, Gunma, Japan
| | - Kohtaro Toyama
- Department of Hematology, Fujioka General Hospital, Fujioka, Gunma, Japan
| | - Takuma Ishizaki
- Department of Hematology, Gunma University Graduate School of Medicine
| | - Takeki Mitsui
- Department of Hematology, Gunma University Graduate School of Medicine
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- Department of Hematology, Gunma University Graduate School of Medicine
| | - Takayuki Saitoh
- Gunma University Graduate School of Health Sciences, Maebashi, Gunma, Japan
| | - Kayoko Murayama
- Division of Hematology and Oncology, Gunma Cancer Center, Ohta, Gunma, Japan
| | - Morio Matsumoto
- Division of Hematology, National Hospital Organization Shibukawa Medical Center, Shibukawa, Gunma, Japan
| | - Morio Sawamura
- Division of Hematology, National Hospital Organization Shibukawa Medical Center, Shibukawa, Gunma, Japan
| | - Hirokazu Murakami
- Gunma University Graduate School of Health Sciences, Maebashi, Gunma, Japan
| | - Junko Hirato
- Clinical Department of Pathology, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Masaru Kojima
- Anatomic and Diagnostic Pathology, Dokkyo University School of Medicine, Mibu, Tochigi, Japan
| | - Yoshihisa Nojima
- Department of Hematology, Gunma University Graduate School of Medicine
| | - Hiroshi Handa
- Department of Hematology, Gunma University Graduate School of Medicine
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11
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Systemic Front Line Therapy of Follicular Lymphoma: When, to Whom and How. Mediterr J Hematol Infect Dis 2016; 8:e2016062. [PMID: 27872742 PMCID: PMC5111519 DOI: 10.4084/mjhid.2016.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 11/04/2016] [Indexed: 02/06/2023] Open
Abstract
The natural history of follicular lymphoma is usually characterized by an indolent course with a high response rate to the first line therapy followed by recurrent relapses, with a time to next treatment becoming shorter after each subsequent treatment line. More than 80% of patients have advanced stage disease at diagnosis. The time of initiation and the nature of the treatment is mainly conditioned by symptoms, tumor burden, lymphoma grading, co-morbidities and patients preference. A number of clinical and biological factors have been determined to be prognostic in this disease, but the majority of them could not show to be predictive of response to treatment, and therefore can’t be used to guide the treatment choice. CD20 expression is the only predictive factor recognized in the treatment of FL and justifies the use of “naked” or “conjugated” anti-CD20 monoclonal antibodies as a single agent or in combination with chemo- or targeted therapy. Nevertheless, as this marker is almost universally found in FL, it has little role in the choice of treatment. The outcome of patients with FL improved significantly in the last years, mainly due to the widespread use of rituximab, autologous and allogeneic transplantation in young and fit relapsed patients, the introduction of new drugs and the improvement in diagnostic accuracy and management of side effects. Agents as new monoclonal antibodies, immuno-modulating drugs, and target therapy have recently been developed and approved for the relapsed setting, while studies to evaluate their role in first line treatment are still ongoing. Here we report our considerations on first line treatment approach and on the potential factors which could help in the choice of therapy.
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12
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Limited Stage Follicular Lymphoma: Current Role of Radiation Therapy. Mediterr J Hematol Infect Dis 2016; 8:e2016041. [PMID: 27648204 PMCID: PMC5016012 DOI: 10.4084/mjhid.2016.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 07/18/2016] [Indexed: 12/04/2022] Open
Abstract
Radiation therapy (RT) alone has been considered for a long time as the standard therapeutic option for limited stage FL, due to its high efficacy in terms of local disease control with a quite significant proportion of “cured” patients (without further relapses at 10–15 years). Multiple therapeutic choices are currently accepted for the management of early stage FL at diagnosis, and better staging procedures as well as better systemic therapy partially modified the role of RT in this setting. RT has also changed in terms of prescribed dose as well as treatment volumes. In this review, we present and discuss the current role of RT for limited stage FL in light of the historical data and the modern RT concepts along with the possible combination with systemic therapy.
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Gastaud L, Rossignol B, Peyrade F, Ré D, Thariat J, Thyss A, Doyen J. Place de la radiothérapie dans la prise en charge des lymphomes malins non hodgkiniens. Cancer Radiother 2016; 20:236-47. [DOI: 10.1016/j.canrad.2016.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 12/27/2015] [Accepted: 01/29/2016] [Indexed: 12/11/2022]
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Vargo JA, Gill BS, Balasubramani GK, Beriwal S. What is the optimal management of early-stage low-grade follicular lymphoma in the modern era? Cancer 2015; 121:3325-34. [PMID: 26042364 DOI: 10.1002/cncr.29491] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 04/02/2015] [Accepted: 04/30/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND Despite international practice guidelines endorsing radiotherapy (RT) as the preferred initial therapy, treatment approaches vary for patients with early-stage follicular lymphoma. The authors engaged the National Cancer Data Base to analyze patterns of care and survival outcomes for patients with early-stage follicular lymphoma in the era of modern therapy. METHODS A National Cancer Data Base retrospective cohort study was conducted of 35,961 patients with lymph node and extranodal, American Joint Committee on Cancer stage I to II, WHO grade 1 to 2 follicular lymphoma who were diagnosed between 1998 and 2012. Univariate and multivariable analyses were performed to identify sociodemographic, treatment, and tumor characteristics that were predictive of overall survival (OS) and treatment use. Propensity score-adjusted Cox proportional hazards ratios for survival in patients treated for follicular lymphoma were used. RESULTS Of the 35,961 patients with follicular lymphoma included in the current study, 63% had stage I disease, 79% were without extranodal disease, and 61% were aged >60 years. RT use decreased from 37% in 1999 to 24% in 2012 (P<.0001), with corresponding significant increases in observation and single-agent chemotherapy. Patients who received RT had 5-year and 10-year OS rates of 86% and 68%, respectively, compared with 74% and 54%, respectively, for those who did not receive RT (P<.0001). On multivariable survival analysis, including a propensity score to account for potential uncaptured confounding variables due to a lack of randomization, upfront RT remained independently associated with improved OS (hazard ratio of death, 0.54; 95% confidence interval, 0.47-0.63 [P<.0001]). CONCLUSIONS RT is an increasingly underused treatment approach in the era of modern therapy for patients with early-stage follicular lymphoma. The use of RT appears to improve OS and should remain standard practice as encouraged by clinical practice guidelines.
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Affiliation(s)
- John A Vargo
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Beant S Gill
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Goundappa K Balasubramani
- Department of Epidemiology, Epidemiology Data Center, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Sushil Beriwal
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
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Janikova A. Radiotherapy in early stage follicular lymphoma: is it really the gold standard? Leuk Lymphoma 2015; 56:2999-3000. [PMID: 25985811 DOI: 10.3109/10428194.2015.1049172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Andrea Janikova
- a Department of Internal Medicine , Hematology and Oncology, Masaryk University and University Hospital Brno , Brno , Czech Republic
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Smith A, Crouch S, Lax S, Li J, Painter D, Howell D, Patmore R, Jack A, Roman E. Lymphoma incidence, survival and prevalence 2004-2014: sub-type analyses from the UK's Haematological Malignancy Research Network. Br J Cancer 2015; 112:1575-84. [PMID: 25867256 PMCID: PMC4453686 DOI: 10.1038/bjc.2015.94] [Citation(s) in RCA: 275] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 02/06/2015] [Accepted: 02/15/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Population-based information about cancer occurrence and survival are required to inform clinical practice and research; but for most lymphomas data are lacking. METHODS Set within a socio-demographically representative UK population of nearly 4 million, lymphoma data (N=5796) are from an established patient cohort. RESULTS Incidence, survival (overall and relative) and prevalence estimates for >20 subtypes are presented. With few exceptions, males tended to be diagnosed at younger ages and have significantly (P<0.05) higher incidence rates. Differences were greatest at younger ages: the <15 year male/female rate ratio for all subtypes combined being 2.2 (95% CI 1.3-3.4). These gender differences impacted on prevalence; most subtype estimates being significantly (P<0.05) higher in males than females. Outcome varied widely by subtype; survival of patients with nodular lymphocyte predominant Hodgkin lymphoma approached that of the general population, whereas less than a third of those with other B-cell (e.g., mantle cell) or T-cell (e.g., peripheral-T) lymphomas survived for ≥5 years. No males/female survival differences were detected. CONCLUSIONS Major strengths of our study include completeness of ascertainment, world-class diagnostics and generalisability. The marked variations demonstrated confirm the requirement for 'real-world' data to inform aetiological hypotheses, health-care planning and the future monitoring of therapeutic changes.
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Affiliation(s)
- A Smith
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - S Crouch
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - S Lax
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - J Li
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - D Painter
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - D Howell
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - R Patmore
- Queens Centre for Oncology, Castle Hill Hospital, Hull HU16 5JQ, UK
| | - A Jack
- St James's Institute of Oncology, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK
| | - E Roman
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, YO10 5DD, UK
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Bilateral conjunctival follicular lymphoma in a child. J AAPOS 2015; 19:183-5. [PMID: 25824110 DOI: 10.1016/j.jaapos.2014.10.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 10/21/2014] [Accepted: 10/26/2014] [Indexed: 11/22/2022]
Abstract
Follicular lymphoma is exceedingly rare in children. We present the case of a 10-year-old patient with a conjunctival lesion on the left eye who later developed a similar lesion on the right eye. Excisional biopsy of the left eye lesion revealed follicular lymphoma. The patient was treated with systemic rituximab. To our knowledge, only 4 other cases of pediatric conjunctival follicular lymphoma have been reported, all of which were isolated lesions that were treated with excisional biopsy alone.
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Abstract
Primary gastrointestinal (GI) lymphomas are uncommon diseases that can involve the whole GI tract. The etiologies of the disease remain unclear, and potential risk factors include celiac disease, Helicobacter pylori infection, use of immunosuppressive agents, human immunodeficiency virus (HIV) or Epstein-Barr virus (EBV) infection and inflammatory bowel disease, etc. Diffuse large B-cell lymphoma (DLBCL) and mucosa-associated lymphoid tissue (MALT) lymphoma are the most common subtypes of GI lymphomas. B-cell lymphomas of the GI tract are more common in Western countries, while in Asia-Pacific region T-cell lymphomas are more frequently reported. In this review, lymphomas in the esophagus, stomach and intestine are described, including their epidemiology, histology, clinical manifestations, endoscopic findings, radiological features and treatment.
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Affiliation(s)
- Jiang Chen Peng
- State Key Laboratory for Oncogenes and Related Genes, Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Division of Gastroenterology and Hepatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai Institute of Digestive Disease, Shanghai Inflammatory Bowel Disease Research Center, Shanghai, China
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Kuruvilla J, Assouline S, Hodgson D, MacDonald D, Stewart D, Christofides A, Komolova M, Connors J. A Canadian Evidence-Based Guideline for the First-Line Treatment of Follicular Lymphoma: Joint Consensus of the Lymphoma Canada Scientific Advisory Board. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15:59-74. [DOI: 10.1016/j.clml.2014.07.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 07/18/2014] [Accepted: 07/29/2014] [Indexed: 11/30/2022]
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Janikova A, Bortlicek Z, Campr V, Kopalova N, Benesova K, Belada D, Prochazka V, Pytlik R, Vokurka S, Pirnos J, Duras J, Mocikova H, Mayer J, Trneny M. Radiotherapy with rituximab may be better than radiotherapy alone in first-line treatment of early-stage follicular lymphoma: is it time to change the standard strategy? Leuk Lymphoma 2015; 56:2350-6. [PMID: 25426666 DOI: 10.3109/10428194.2014.990010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Early-stage follicular lymphoma (FL) has traditionally been treated with involved-field radiotherapy (RT). Rituximab (R) is a low-toxic, efficient systemic therapy for FL, but there are no data about its clinical impact in early FL. We retrospectively analyzed 93 patients with stage I-II indolent FL treated with RT (n=65) or RT+R (n=14) or R alone (n=14). Median follow-up was 5.0 years for patients with RT, 2.8 years for the RT+R subgroup and 2.5 years for patients treated with R. The complete response rate was 92%, 100% and 86% (not significant) and the median PFS was 3.3 years, not reached and 4.9 years (p=0.035) for the RT, RT+R and R arms, with no impact on overall survival. R combined with RT seems to give better results in terms of global FL control, but longer follow-up and prospective comparison are needed to verify these results.
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Affiliation(s)
- Andrea Janikova
- a Department of Internal Medicine - Hematology and Oncology , Masaryk University and University Hospital Brno , Brno , Czech Republic
| | - Zbynek Bortlicek
- b Institute of Biostatistics and Analyses, Faculty of Medicine and Faculty of Science, Masaryk University , Brno , Czech Republic
| | - Vit Campr
- c Department of Pathology and Molecular Medicine , 2nd Faculty of Medicine, Charles University and Faculty Hospital in Motol , Prague , Czech Republic
| | - Natasa Kopalova
- a Department of Internal Medicine - Hematology and Oncology , Masaryk University and University Hospital Brno , Brno , Czech Republic
| | - Katerina Benesova
- d 1st Department of Medicine , Charles University General Hospital , Prague , Czech Republic
| | - David Belada
- e Department of Clinical Hematology , University Hospital Hradec Kralove , Hradec Kralove , Czech Republic
| | - Vit Prochazka
- f Department of Hematology , University Hospital Olomouc , Olomouc , Czech Republic
| | - Robert Pytlik
- d 1st Department of Medicine , Charles University General Hospital , Prague , Czech Republic
| | - Samuel Vokurka
- g Department of Hematooncology , Charles University and University Hospital Pilsen , Pilsen , Czech Republic
| | - Jan Pirnos
- h Department of Oncology , Hospital Ceske Budejovice , Ceske Budejovice , Czech Republic
| | - Juraj Duras
- i Department of Clinical Hematology , Teaching Hospital Ostrava , Ostrava , Czech Republic
| | - Heidi Mocikova
- j Department of Hematology , University Hospital Kralovske Vinohrady , Prague , Czech Republic
| | - Jiri Mayer
- a Department of Internal Medicine - Hematology and Oncology , Masaryk University and University Hospital Brno , Brno , Czech Republic
| | - Marek Trneny
- d 1st Department of Medicine , Charles University General Hospital , Prague , Czech Republic
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Sarkozy C, Salles G, Bachy E. Chemotherapy-free treatment in patients with follicular lymphoma. Expert Rev Hematol 2015; 8:187-203. [PMID: 25585961 DOI: 10.1586/17474086.2015.998995] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The outcome of patients with follicular lymphoma (FL) has improved over the last two decades through the introduction of anti-CD20 monoclonal antibodies, usually used in combination with chemotherapy. However, patients with FL still experience multiple relapses, requiring several lines of treatment. Early toxicity of chemotherapy is a significant concern and as the life expectancy of patients with FL is increasing, late toxicities become an increasingly important concern. Progress made in understanding the biology of FL, especially dysregulation of intracellular pathways and immunological antitumor responses, recently allowed for the development of innovative chemo-free therapeutic approaches. In this report, different options such as new anti-CD20 antibodies, antibodies targeting other cell surface antigens, bi-specific antibodies, immunomodulation, idiotype vaccine and other targeted therapies are presented. The article also highlights how, although promising in early phase studies, the cost-effectiveness of new agents will have to be justified in Phase III trials. Furthermore, chemo-free regimen might not mean toxicity-free treatment and monitoring of early and late toxicities is required.
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Affiliation(s)
- Clémentine Sarkozy
- Hospices Civils de Lyon, Service d'Hématologie, 69495 Pierre Bénite cedex, France
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Aguiar-Bujanda D, Blanco-Sánchez MJ, Jiménez-Gallego P, Mori-De Santiago M, Hernández-Sosa M, Galván-Ruíz S, Hernández-Sarmiento S, Saura-Grau S, Bohn-Sarmiento U. Therapeutic approaches in patients with newly diagnosed follicular lymphoma. Future Oncol 2014; 10:1967-80. [DOI: 10.2217/fon.14.104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
ABSTRACT The prognosis of follicular lymphoma (FL) has significantly improved over the last decade, particularly following the introduction of the anti-CD20 monoclonal antibody rituximab, which has challenged the old concept of FL as an incurable disease. However, the decision whether to start treatment in a patient with advanced FL or adopt a watch-and-wait policy remains a subject of controversy. Furthermore, the optimal first-line treatment for FL remains a clinical challenge owing to the numerous different therapeutic options available. In this review, the authors focus on the initial management of patients with newly diagnosed FL, consider the different treatment options for every stage, paying special consideration to the therapeutic approaches for each clinical scenario, and discuss future directions.
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Affiliation(s)
- David Aguiar-Bujanda
- Department of Medical Oncology, Hospital Universitario de Gran Canaria Dr Negrin, C/Barranco de la Ballena s/n, 35010, Las Palmas de Gran Canaria, Spain
| | - María Jesús Blanco-Sánchez
- Department of Medical Oncology, Hospital Universitario de Gran Canaria Dr Negrin, C/Barranco de la Ballena s/n, 35010, Las Palmas de Gran Canaria, Spain
| | - Pedro Jiménez-Gallego
- Department of Medical Oncology, Hospital Universitario de Gran Canaria Dr Negrin, C/Barranco de la Ballena s/n, 35010, Las Palmas de Gran Canaria, Spain
| | - Marta Mori-De Santiago
- Department of Medical Oncology, Hospital Universitario de Gran Canaria Dr Negrin, C/Barranco de la Ballena s/n, 35010, Las Palmas de Gran Canaria, Spain
| | - María Hernández-Sosa
- Department of Medical Oncology, Hospital Universitario de Gran Canaria Dr Negrin, C/Barranco de la Ballena s/n, 35010, Las Palmas de Gran Canaria, Spain
| | - Saray Galván-Ruíz
- Department of Medical Oncology, Hospital Universitario de Gran Canaria Dr Negrin, C/Barranco de la Ballena s/n, 35010, Las Palmas de Gran Canaria, Spain
| | - Samuel Hernández-Sarmiento
- Department of Medical Oncology, Hospital Universitario de Gran Canaria Dr Negrin, C/Barranco de la Ballena s/n, 35010, Las Palmas de Gran Canaria, Spain
| | - Salvador Saura-Grau
- Department of Medical Oncology, Hospital Universitario de Gran Canaria Dr Negrin, C/Barranco de la Ballena s/n, 35010, Las Palmas de Gran Canaria, Spain
| | - Uriel Bohn-Sarmiento
- Department of Medical Oncology, Hospital Universitario de Gran Canaria Dr Negrin, C/Barranco de la Ballena s/n, 35010, Las Palmas de Gran Canaria, Spain
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Rapid decline of follicular lymphoma-associated chylothorax after low dose radiotherapy to retroperitoneal lymphoma localization. Case Rep Hematol 2014; 2014:684689. [PMID: 24891961 PMCID: PMC4033525 DOI: 10.1155/2014/684689] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 04/27/2014] [Indexed: 01/30/2023] Open
Abstract
Chylothorax is caused by disruption or obstruction of the thoracic duct or its tributaries that results in the leakage of chyle into the pleural space. A number of interventions have been used to treat chylothorax including the treatment of the underlying disease. Lymphoma is found in 70% of cases with nontraumatic malignant aetiology. Although patients usually have advanced lymphoma, supradiaphragmatic disease is not always present. We discuss the case of a 63-year-old woman presenting with progressive respiratory symptoms due to chylothorax. She was diagnosed with a stage IIE retroperitoneal grade 1 follicular lymphoma extending from the coeliac trunk towards the pelvic inlet. Despite thoracocentesis and medium-chain triglycerides (MCT), diet chylothorax reoccurred. After low dose radiotherapy (2 × 2 Gy) to the abdominal lymphoma there was a marked decrease in lymphadenopathy at the coeliac trunk and a complete regression of the pleural fluid. In this case, radiotherapy was shown to be an effective nontoxic treatment option for lymphoma-associated chylothorax with long-term remission of pleural effusion.
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Mamessier E, Broussais-Guillaumot F, Chetaille B, Bouabdallah R, Xerri L, Jaffe ES, Nadel B. Nature and importance of follicular lymphoma precursors. Haematologica 2014; 99:802-10. [PMID: 24790058 PMCID: PMC4008113 DOI: 10.3324/haematol.2013.085548] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 02/10/2014] [Indexed: 11/09/2022] Open
Abstract
It is now widely recognized that cancer development is a protracted process requiring the stepwise acquisition of multiple oncogenic events. In humans, this process can take decades, if not a lifetime, blurring the notion of 'healthy' individuals. Follicular lymphoma exemplifies this multistep pathway of oncogenesis. In recent years, variants of follicular lymphoma have been recognized that appear to represent clonal B-cell expansions at an early stage of follicular lymphoma lymphomagenesis. These include follicular lymphoma in situ, duodenal follicular lymphoma, partial involvement by follicular lymphoma, and in the blood circulating follicular lymphoma-like B cells. Recent genetic studies have identified similarities and differences between the early lesions and overt follicular lymphoma, providing important information for understanding their biological evolution. The data indicate that there is already genomic instability at these early stages, even in instances with a low risk for clinical progression. The overexpression of BCL2 in t(14;18)-positive B cells puts them at risk for subsequent genetic aberrations when they re-enter the germinal center and are exposed to the influences of activation-induced cytidine deaminase and somatic hypermutations. The emerging data provide a rationale for clinical management and, in the future, may identify genetic risk factors that warrant early therapeutic intervention.
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Rapidly progressed primary intestinal follicular lymphoma with elevation of soluble interleukin-2 receptor levels. Case Rep Oncol Med 2014; 2014:549248. [PMID: 24876980 PMCID: PMC4021836 DOI: 10.1155/2014/549248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 04/15/2014] [Indexed: 12/19/2022] Open
Abstract
A 62-year-old Japanese male was diagnosed with primary intestinal follicular lymphoma involving the duodenum, jejunum, and rectum without lymph node involvement. The patient was classified as low risk by the follicular lymphoma international prognostic index (FLIPI) system. Treatment was deferred because he had no symptoms. Eleven months after the diagnosis, his soluble interleukin-2 receptor (sIL-2R) levels had risen from 383 to 617 U/mL. Lymphoma progression involving an enlarged perigastric lymph node was also documented. This report illustrates a case of rapidly progressed intestinal follicular lymphoma, suggesting the possible usefulness of sIL-2R levels as an indicator of lymphoma progression.
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