Challenges

• Patients with follicular lymphoma FL most often present with advanced disease, which may have gone undiagnosed for years because the indolent form of the disease is usually asymptomatic.¹
• Although initially responsive to treatment, FL repeatedly relapses and requires additional rounds of therapy.²
• The short- and long-term effects of chemotherapy regimens can affect health-related quality of life and potentially increase the risk of cardiovascular events and of secondary cancers.³
• Approximately 45% of patients will develop an aggressive form of the disease by transformation into diffuse large B-cell lymphoma DLBCL.²
• Although the incorporation of rituximab into treatment regimens for FL has improved overall survival, patients who do not respond to rituximab have a poor prognosis.⁴
• Histological transformation cannot yet be reliably predicted, and all patients are potentially at risk for developing the more aggressive subtype for at least 15 years after initial diagnosis.⁵
• The natural history and tumor biology of follicular lymphoma is only partially understood.⁶
• Given the rapid evolution of the field and the many treatment options available, it is difficult to define the best management of FL, which FL patients to treat, the optimal duration of treatment, and the optimal use of treatment modalities (eg, chemotherapy, radioimmunotherapy, radiotherapy).⁷
• Although the development of novel agents for FL is an exciting opportunity, how and when to incorporate these agents into existing management practices remains under investigation.³

References

1. Hiddemann W, Cheson BD. How we manage follicular lymphoma. Leukemia. 2014;28:1388-1395.
2. Schatz JH, Oricchio E, Puvvada SD, Wendel HG. Progress against follicular lymphoma. Curr Opin Hematol. 2013;20:320-326.
3. Bachy E, Salles G. Are we nearing an era of chemotherapy-free management of indolent lymphoma? Clin Cancer Res; 2014;20:5226-5239.
4. Casulo C, Byrtek M, Dawson KL, et al. Early relapse of follicular lymphoma after rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone defines patients at high risk for death: an analysis from the National LymphoCare Study. J Clin Oncol. 2015;33:2516-2522.
5. Casulo C, Burack WR, Friedberg JW. Transformed follicular non-Hodgkin lymphoma. Blood. 2015;125:40-47.
6. Kridel R, Sehn LH, Gascoyne RD. Pathogenesis of follicular lymphoma. J Clin Invest. 2012;122:3424-3431.
7. Friedberg JW, Taylor MD, Cerhan JR, et al. Follicular lymphoma in the United States: First report of the National LymphoCare Study. J Clin Oncol. 2009;27:1202-1208.