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Review
. 2017 Jan 1;9(1):e2017009.
doi: 10.4084/MJHID.2017.009. eCollection 2017.

Follicular Lymphoma: The Management of Elderly Patient

Alessia Castellino  1 , Elisa Santambrogio  1 , Maura Nicolosi  1 , Barbara Botto  1 , Carola Boccomini  1 , Umberto Vitolo  1
Affiliations
Review

Follicular Lymphoma: The Management of Elderly Patient

Alessia Castellino et al. Mediterr J Hematol Infect Dis. .

Abstract

Follicular lymphoma (FL) is the most common indolent non-Hodgkin lymphoma, which typically affects mature adults and elderly, whose median age at diagnosis is 65 years. The natural history of FL appears to have been favorably impacted by the introduction of Rituximab. Randomized clinical trials demonstrated that the addition of rituximab to standard chemotherapy induction has improved the overall survival and new strategies of chemo-immunotherapy, such as Bendamustine combined with Rituximab, showed optimal results on response and reduced hematological toxicity, becoming one of the standard treatments, particularly in elderly patients. Moreover, maintenance therapy with Rituximab demonstrated improvement of progression-free survival. Despite these exciting results, FL is still an incurable disease. It remains a critical unmet clinical need finding new prognostic factors to identify poor outcome patients better, to reduce the risk of transformation and to explore new treatment strategies, especially for patients not candidate to intensive chemotherapy regimens, such as elderly patients. Some progress were already reached with novel agents, but larger and more validated studies are needed. Elderly patients are the largest portion of patients with FL and represent a subgroup with higher treatment difficulties, because of comorbidities and smaller spectrum for treatment choice. Further studies, focused on elderly follicular lymphoma patients, with their peculiar characteristics, are needed to define the best-tailored treatment at diagnosis and at the time of relapse in this setting.

Keywords: Comorbidities; Elderly; Follicular Lymphoma.

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Figures

Figure 1
Figure 1
Simplified Comprehensive Geriatric Assessment score.
Figure 2
Figure 2
2years- Progression Free Survival (2y-PFS) according to age and comorbidities in phase III trial ML17638.
Figure 3
Figure 3
7 years-Progression Free Survival (7y-PFS) and 7 years-Overall Survival (7y-OS) from recent update of phase III trial ML17638.
Figure 4
Figure 4
7 years-Progression Free Survival (7y-PFS) according to minimal resudual disease (MRD) in phase III trial ML17638.
See this image and copyright information in PMC

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