NCCN Guidelines® Insights: B-Cell Lymphomas, Version 5.2021

Abstract

In the last decade, a better understanding of the molecular pathogenesis of B-cell non-Hodgkin lymphomas has resulted in the development of novel targeted therapies, such as small molecule inhibitors of select kinases in the B-cell receptor pathway, antibody–drug conjugates, and small molecules that target a variety of proteins (eg, CD-19, EZH2, and XPO-1–mediated nuclear export). Anti-CD19 CAR T-cell therapy, first approved for relapsed/refractory (R/R) diffuse large B-cell lymphoma, has also emerged as a novel treatment option for R/R follicular lymphoma and mantle cell lymphoma. These NCCN Guideline Insights highlight the new targeted therapy options included in the NCCN Guidelines for B-Cell Lymphomas for the treatment of R/R disease.

A Favorable Outcome of Grade 3 Follicular Lymphoma Treated With Surgery and Obinutuzumab Combined With Chemotherapy: A Case Report and Literature Review

“…Although clinicians can utilize the FLIPI score to identify the prognostic predictors of follicular lymphoma, this score was created to help predict survival rates at the time of diagnosis and was not developed with the intention to use them for treatment selection or to predict survival after treatment has been initiated [ 8 , 12 - 14 ]. Despite the low FLIPI score in our patient, his index did not necessarily reflect survival or guide decisions for treatment options (Table 1 ).…”

“…These findings warrant consideration to proceed with treatment for patients, especially those who are symptomatic. Our patient was symptomatic, as he presented with small bowel obstruction, leading to the decision to proceed with more aggressive management of his disease, although the current treatment for grade 3A follicular lymphoma is controversial [ 14 ]. In the post-rituximab era, patients with grade 3a or 3b follicular lymphoma showed a better prognosis regardless of the stage and/or patient’s age at the time of presentation [ 9 ].…”

“…In the post-rituximab era, patients with grade 3a or 3b follicular lymphoma showed a better prognosis regardless of the stage and/or patient’s age at the time of presentation [ 9 ]. Because of the differences in prognosis and therapeutic benefit of focal grade 3 lymphoma, it was decided to treat our patient with curative intent as DLBCL, ultimately preventing the aggressive transformation of this indolent lymphoma [ 14 ].…”

“…In continuing the challenge in treating our patient’s condition, studies reviewing the significance of extranodal maximum tumor diameter (EN-MTD) in the treatment of DLBCL have demonstrated that patients have a higher progression-free survival rate if their EN-MDT was <7.5 cm [ 17 - 19 ]. Our patient had promising prognostic factors because of his EN-MDT < 7.5 cm, but his less favorable clinical presentation of malignancy-related SBO eventually led the clinical team to treat him as if he had “bulky” DLBCL (defined as mass ≥ 7.5 cm) [ 14 , 17 , 18 ]. Ultimately, our patient received six cycles of R-CHOP (transitioned to O-CHOP due to tolerability), with a complete successful response to chemotherapy [ 14 , 18 ].…”

“…Our patient had promising prognostic factors because of his EN-MDT < 7.5 cm, but his less favorable clinical presentation of malignancy-related SBO eventually led the clinical team to treat him as if he had “bulky” DLBCL (defined as mass ≥ 7.5 cm) [ 14 , 17 , 18 ]. Ultimately, our patient received six cycles of R-CHOP (transitioned to O-CHOP due to tolerability), with a complete successful response to chemotherapy [ 14 , 18 ]. It is worth noting that the initial goal of developing a humanized type II monoclonal antibody (mAb) against CD20, also known as obinutuzumab or GA101, was the need for new treatments for patients with B-cell lymphomas, as well as alternatives for anti-CD20 drug hypersensitivity reactions (DHR) [ 20 ].…”