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Review
. 2024 May 30;41(2):69-82.
doi: 10.4274/tjh.galenos.2024.2024.0015. Epub 2024 Apr 25.

Advancements in the Management of Follicular Lymphoma: A Comprehensive Review

Reid Merryman  1 , Özgür Mehtap  2 , Ann LaCasce  1
Affiliations
Review

Advancements in the Management of Follicular Lymphoma: A Comprehensive Review

Reid Merryman et al. Turk J Haematol. .

Abstract
in English, Turkish

Follicular lymphoma (FL) is the most common subtype of indolent non-Hodgkin lymphoma in Western countries. While FL is generally incurable, standard initial therapies are associated with high response rates and durable remissions for most patients. In addition, novel targeted agents and immunotherapies are changing the treatment algorithm for patients with relapsed or refractory disease. This review discusses the initial staging, prognosis, and treatment options for newly diagnosed and relapsed/refractory FL. Initial treatment options for FL include active surveillance, radiotherapy, rituximab monotherapy, and chemoimmunotherapy. Staging with positron emission tomography/computed tomography and bone marrow biopsy is crucial for identifying early-stage patients. Most patients with FL will receive chemoimmunotherapy as the initial treatment with options including rituximab or obinutuzumab plus cyclophosphamide, vincristine, and prednisone; cyclophosphamide, doxorubicin, vincristine, and prednisone; bendamustine; or lenalidomide. No significant differences in overall survival have been observed in randomized studies comparing these regimens. Maintenance therapy with rituximab or obinutuzumab in responders to initial chemoimmunotherapy improves progression-free survival. For relapsed/refractory FL, treatment options include chemoimmunotherapy, lenalidomide-based regimens, tazemetostat, chimeric antigen receptor (CAR)-T cell therapy (axicabtagene ciloleucel and tisagenlecleucel), and CD3/CD20 bispecific antibodies (BsAbs). Given the encouraging outcomes obtained with CAR-T cell therapy and BsAbs, multiple trials are testing these highly active agents in earlier lines of therapy and among high-risk patients with early relapse after frontline chemoimmunotherapy. Additional studies and follow-up are needed to understand how these novel agents may further change treatment algorithms for FL.

Foliküler lenfoma (FL), Batı ülkelerindeki indolent non-Hodgkin lenfomanın en yaygın alt türüdür. FL genellikle tedavi edilemez olsa da, standart başlangıç tedavileri çoğu hastada yüksek yanıt oranları ve sürdürülebilir remisyonlarla ilişkilidir. Ayrıca, yeni hedefli ajanlar ve immünoterapiler, relaps veya refrakter hastalığı olan hastaların tedavi algoritmalarını değiştirmektedir. Bu derleme, yeni tanı konmuş ve relaps/refrakter FL için başlangıç evrelemesi, prognoz ve tedavi seçeneklerini tartışmaktadır. FL için başlangıç tedavi seçenekleri arasında aktif gözetim, radyoterapi, rituksimab monoterapisi ve kemoimmünoterapi yer almaktadır. Pozitron emisyon tomografisi/bilgisayarlı tomografi ve kemik iliği biyopsisi ile evreleme, erken evre hastaları tanılamak için kritiktir. FL hastalarının çoğu, rituksimab veya obinutuzumab ile birlikte siklofosfamid, vinkristin, prednizon, siklofosfamid, doksorubisin, vinkristin, prednizon, bendamustin veya lenalidomid gibi seçenekleri içeren kemoimmünoterapiyi başlangıç tedavisi olarak alacaktır. Bu rejimleri karşılaştıran randomize çalışmalarda genel sağkalımda önemli farklar gözlemlenmemiştir. Rituksimab veya obinutuzumab ile idame tedavisi, başlangıç kemoimmünoterapisine yanıt veren hastalarda progresyonsuz sağkalımı artırır. Relaps/refrakter FL için tedavi seçenekleri, kemoimmünoterapi, lenalidomide tabanlı rejimler, tazemetostat, kimerik antijen reseptörü (CAR)-T-hücre terapisi (aksikabtagen sileulesel ve tisagenlecleucel) ve CD3/CD20 bispesifik antikorlar (BsAb) içermektedir. CAR-T hücre tedavisi ve BsAb’lerle umut verici sonuçlar alındığından, bu yüksek etkili ajanların tedavi algoritmalarını FL’nin ön tedaviden sonraki erken relapsı olan yüksek riskli hastalarda test etmek için birçok çalışma yapılmaktadır. Bu yeni ajanların FL için tedavi algoritmalarını nasıl daha fazla değiştirebileceğini anlamak için ek çalışmalar ve takip gereklidir.

Keywords: Review; Follicular lymphoma; Treatment management.

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Conflict of interest statement

Conflict of Interest: No conflict of interest was declared by the authors.

References

    1. Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, Thiele J. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. Revised 4th Edition. Lyon, IARC Press, 2017.
    1. Freedman A. Follicular lymphoma: 2018 update on diagnosis and management. Am J Hematol . 2018;93(2):296–305. doi: 10.1002/ajh.24937. - DOI - PubMed
    1. Koch K, Hoster E, Ziepert M, Unterhalt M, Ott G, Rosenwald A, Hansmann ML, Bernd W, Stein H, Pöschel V, Dreyling M, Trümper L, Löffler M, Schmitz N, Hiddemann W, Pfreundschuh M, Klapper W. Clinical, pathological and genetic features of follicular lymphoma grade 3A: a joint analysis of the German low-grade and high-grade lymphoma study groups GLSG and DSHNHL. Ann Oncol . 2016;27(7):1323–1329. doi: 10.1093/annonc/mdw185. - DOI - PubMed
    1. Alaggio R, Amador C, Anagnostopoulos I, Attygalle AD, Araujo IBO, Berti E, Bhagat G, Borges AM, Boyer D, Calaminici M, Chadburn A, Chan JKC, Cheuk W, Chng WJ, Choi JK, Chuang SS, Coupland SE, Czader M, Dave SS, de Jong D, Du MQ, Elenitoba-Johnson KS, Ferry J, Geyer J, Gratzinger D, Guitart J, Gujral S, Harris M, Harrison CJ, Hartmann S, Hochhaus A, Jansen PM, Karube K, Kempf W, Khoury J, Kimura H, Klapper W, Kovach AE, Kumar S, Lazar AJ, Lazzi S, Leoncini L, Leung N, Leventaki V, Li XQ, Lim MS, Liu WP, Louissaint A Jr, Marcogliese A, Medeiros LJ, Michal M, Miranda RN, Mitteldorf C, Montes-Moreno S, Morice W, Nardi V, Naresh KN, Natkunam Y, Ng SB, Oschlies I, Ott G, Parrens M, Pulitzer M, Rajkumar SV, Rawstron AC, Rech K, Rosenwald A, Said J, Sarkozy C, Sayed S, Saygin C, Schuh A, Sewell W, Siebert R, Sohani AR, Tooze R, Traverse-Glehen A, Vega F, Vergier B, Wechalekar AD, Wood B, Xerri L, Xiao W. The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: Lymphoid Neoplasms. Leukemia . 2022;36(7):1720–1748. doi: 10.1038/s41375-022-01620-2. - DOI - PMC - PubMed
    1. Horn H, Schmelter C, Leich E, Salaverria I, Katzenberger T, Ott MM, Kalla J, Romero M, Siebert R, Rosenwald A, Ott G. Follicular lymphoma grade 3B is a distinct neoplasm according to cytogenetic and immunohistochemical profiles. Haematologica . 2011;96(9):1327–1334. doi: 10.3324/haematol.2011.042531. - DOI - PMC - PubMed

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