Therapeutic Approaches in Patients With Newly Diagnosed Follicular Lymphoma

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.

Primary lymphomas in the gastrointestinal tract

“…A retrospective study showed that the 7.5‐year overall survival (OS) rate was similar among patients having localized FL who were treated with chemotherapy, radiotherapy, surveillance and chemotherapy in combination with radiotherapy. Rituximab together with chemotherapy, which has been proven to be more effective than chemotherapy alone, is recommended for patients with aggressive FL as the first‐line treatment . And rituximab to hyper‐fractionated cyclophosphamide, vincristine, adriamycin and dexamethasone, with cytarabine plus methotrexate (R‐hyper‐CVAD) has been proven to be effective for the treatment of BL, when patients could tolerate the regimen well …”

“…Rituximab together with chemotherapy, which has been proven to be more effective than chemotherapy alone, is recommended for patients with aggressive FL as the first-line treatment. 82 And rituximab to hyper-fractionated cyclophosphamide, vincristine, adriamycin and dexamethasone, with cytarabine plus methotrexate (R-hyper-CVAD) has been proven to be effective for the treatment of BL, when patients could tolerate the regimen well. 83…”

Tumor Heterogeneity in Lymphomas: A Different Breed

“…This complex classification, which tries to group lymphomas according to their putative cell of origin, as well as their clinical and pathological features, reflects our deepening understanding of the immune system, with different lymphocyte subsets undergoing complex maturation steps and each step potentially having malignant counterparts. The precise classification of a patient's lymphoma is crucial to predict the clinical course (from indolent to aggressive) and to guide the choice of treatment regimen, from "watch and wait" to multimodal (radio-, immuno-, chemo-) therapy [16][17][18][19]. Histomorphologic and cytologic analyses of the growth pattern, tissue architecture, cell size, nuclear features, and reactive microenvironment of a given tumor by microscopy of stained tissue slides are still the most important tools for establishing a diagnosis of lymphoma.…”

“…At first diagnosis, it is important to classify the lymphoma correctly because the best therapy for an individual patient can vary from "watch and wait" to multimodal (radio-, immuno-, and chemo-) therapy, depending on variables such as disease subtype, evidence for high-grade transformation, and various molecular risk factors [16][17][18][19].…”