Time for an individualized approach to first-line management of follicular lymphoma

Cartron, Guillaume; Trotman, Judith

doi:10.3324/haematol.2021.278766

Cited by 19 publications

(12 citation statements)

References 77 publications

(96 reference statements)

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“…Currently, the initiation and selection of the treatment from various guidelines are based on symptoms, staging of the disease according to the Ann Arbor classification system, histological grading, and tumour burden assessment with GELF, BNLI, or NCCN criteria [ 11 ]. The watch-and-wait (W/W) approach is generally implemented for patients with asymptomatic, low tumour burden, stage II–IV low-grade FL until the occurrence of symptoms or signs of advancing lymphoma (e.g., B symptoms, bulky disease, organ involvement, ascites or pleural effusion, rapid progression, or bone marrow infiltration with cytopenias) [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Managing Follicular Lymphoma in the Elderly Population

Tan

Sze

Hui

2023

Case Reports in Medicine

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Follicular lymphoma (FL) is one of the most commonly diagnosed types of indolent non-Hodgkin lymphoma (NHL). The median age of diagnosis for FL is 65 years old. Although the median life expectancy after diagnosis is approximately 10 years, the incurable disease has a high risk of transformation. This case report focuses on an 80-year-old patient diagnosed with low-grade follicular lymphoma which subsequently transformed leading to the patient’s eventual demise as the patient took on the palliative intent. This case report aims to highlight the importance of clinical markers or prognostic factors to identify patients, specifically the elderly population who are at risk of transformation to aggressive forms when their FL remains at stage I-II phases. Currently, elderly patients with FL tend to be quickly dismissed with curative intent with chemotherapy, given their age and comorbidities, despite forming the majority of the population with follicular lymphoma. Age more than 60 years old has been shown to be one of the most powerful yet poor prognostic features in follicular lymphoma international prognostic index (FLIPI)—the main scoring system used for FL. Hence, further studies are required to look into the tailoring treatment for elderly patients with follicular lymphoma after risk stratifying them with appropriate clinical and prognostic markers.

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Section: Discussionmentioning

confidence: 99%

Managing Follicular Lymphoma in the Elderly Population

Tan

Sze

Hui

2023

Case Reports in Medicine

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“…Therefore, it remains to be determined if the m7-FLIPI risk score is prognostic for FL patients treated with other chemotherapy regimes other than R-CHOP. Furthermore, the use of such risk scores in the routine clinical practice is not common, partly due to lack of availability of mutational studies in some centers[ 41 ].…”

Section: Molecular Analyses In Flmentioning

confidence: 99%

Integration of molecular testing for the personalized management of patients with diffuse large B-cell lymphoma and follicular lymphoma

Stuckey¹,

Henríquez²,

Melian³

et al. 2023

World J Clin Oncol

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Diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL) are the most common forms of aggressive and indolent lymphoma, respectively. The majority of patients are cured by standard R-CHOP immunochemotherapy, but 30%–40% of DLBCL and 20% of FL patients relapse or are refractory (R/R). DLBCL and FL are phenotypically and genetically hereterogenous B-cell neoplasms. To date, the diagnosis of DLBCL and FL has been based on morphology, immunophenotyping and cytogenetics. However, next-generation sequencing (NGS) is widening our understanding of the genetic basis of the B-cell lymphomas. In this review we will discuss how integrating the NGS-based characterization of somatic gene mutations with diagnostic or prognostic value in DLBCL and FL could help refine B-cell lymphoma classification as part of a multidisciplinary pathology work-up. We will also discuss how molecular testing can identify candidates for clinical trials with targeted therapies and help predict therapeutic outcome to currently available treatments, including chimeric antigen receptor T-cell, as well as explore the application of circulating cell-free DNA, a non-invasive method for patient monitoring. We conclude that molecular analyses can drive improvements in patient outcomes due to an increased understanding of the different pathogenic pathways affected by each DLBCL subtype and indolent FL vs R/R FL.

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“…12,13 R-CVP/CHOP remains a viable frontline option for many patients in Europe and North America. 14,15 The use of BR in management of indolent lymphomas is relatively new, and few studies have examined the outcomes of patients treated with BR compared to those treated with R-CVP/CHOP. 16 There has been a paucity of studies focusing on real-world evidence looking at toxicities and healthcare utilization in patients treated with BR, and few studies have examined toxicities of maintenance therapy.…”

Section: O R I G I N a L P A P E Rmentioning

confidence: 99%

“…Recent studies have also described increased toxicities in older patients, questioning the tolerability of bendamustine‐containing regimens in this patient population 12,13 . R‐CVP/CHOP remains a viable frontline option for many patients in Europe and North America 14,15 …”

Section: Introductionmentioning

confidence: 99%

Outcomes of patients with indolent lymphoma treated with bendamustine plus rituximab compared to rituximab plus CVP or CHOP chemoimmunotherapy in Ontario

et al. 2023

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SummaryBendamustine (B) with rituximab (R) has become the preferred regimen for patients with indolent lymphoma in Ontario, Canada, compared to R with cyclophosphamide, vincristine, prednisone (CVP) or cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP). We conducted a propensity‐matched retrospective cohort population‐based study of patients treated with R‐CVP/CHOP from 2005 to 2012 and patients treated with BR from 2013 to 2018. The primary outcome was 5‐year overall survival (OS), and secondary outcomes included toxicities and healthcare utilization. The 5‐year OS for patients treated with BR (n = 2023) and R‐CVP/CHOP (n = 2023) was 80% and 75% respectively. Treatment with BR was associated with improved OS (HR 0.79, 95% CI 0.69–0.91). During the first 9 months, patients treated with BR versus R‐CVP/CHOP had a higher number of admissions for infection (22% compared to 17%, p < 0.01) and a higher number of mean ED visits (mean 1.01 ± 1.68 visits vs. 0.85 ± 1.51 visits, p < 0.01). This trend persisted for 3 years. The adjusted 5‐year OS for patients 75 years and older did not differ based on treatment regimen (55.5% for BR vs. 55.4% for R‐CVP/CHOP). Our study supports the use of BR for patients with indolent lymphoma requiring treatment but suggests increased risk of certain toxicities warranting careful patient selection.

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Time for an individualized approach to first-line management of follicular lymphoma

Cited by 19 publications

References 77 publications

Managing Follicular Lymphoma in the Elderly Population

Managing Follicular Lymphoma in the Elderly Population

Integration of molecular testing for the personalized management of patients with diffuse large B-cell lymphoma and follicular lymphoma

Outcomes of patients with indolent lymphoma treated with bendamustine plus rituximab compared to rituximab plus CVP or CHOP chemoimmunotherapy in Ontario

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