The paradigm of watch and wait for lowtumorburden follicular lymphoma ltbfl was established in an era when the treatment options were more lim. Is there a role for watch and wait in follicular lymphoma in the rituximab era. Fl includes watchandwait, singleagent rituximab vs. Watchful waiting in lowtumor burden follicular lymphoma in the rituximab era. Rituximab plus chemotherapy has been shown to be effective in patients with advancedstage, previously untreated follicular lymphoma. R in a randomized phase iii trial in 5 patients with advanced follicular, indolent, and mantle cell lymphoma. In general, the treatment approach for patients with stage ii fl includes watch andwait, singleagent rituximab vs rituximab plus chemotherapy. Rituximab stretches survival in follicular lymphoma.
Follicular lymphoma treatment, prognosis, symptoms, and. These drugs work together in different ways to fight cancer. Thus, delayed initial therapy remains a reasonable approach for selected follicular lymphoma patients. Follicular lymphoma is a common type of non hodgkin lymphoma nhl and is generally classed as a low grade lymphoma. Rituximab with or without ibrutinib for patients with. Evidencebased recommendations on lenalidomide revlimid with rituximab for previously treated follicular lymphoma grade 1 to 3a in adults is this guidance up to date. Follicular lymphoma fl is a cancer that involves certain types of white blood cells known as lymphocytes. Is there a role for watch and wait in follicular lymphoma in the. Rituxan for the treatment of follicular cd20positive nonhodgkins lymphoma as an initial treatment with cvp chemotherapy the most common side effects reported more often in patients receiving rituxan and cvp chemotherapy vs. Watchful waiting is the current standard treatment for stages iii and iv ann arbor classification follicular lymphoma with low. Follicular lymphoma fl is the second most common lymphoma subtype in the united states and western europe, accounting for approximately 25% of all nonhodgkin lymphoma cases and 70% of indolent lymphomas. A rituximabcontaining monotherapy induction strategy for asymptomatic advancedstage follicular lymphoma is the dominant strategy over a watch and wait approach and maximizes both life expectancy and qualityadjusted life expectancy while being costsaving, wrote anca prica, md, of the division of hematology at princess margaret cancer. In patients with follicular lymphoma, the treatment with anticd20 monoclonal antibodies rituximab has proven its superiority both in the induction therapy and maintenance of remission as in case of diseases relapses. Follicular lymphoma fl is the second most frequent type of lymphoma subtype.
Cvp chemotherapy alone were infusionrelated reactions, decreased white blood cell counts, rash, cough, flushing. Is watch and wait still acceptable for patients with lowgrade. The paradigm of watch and wait for low tumorburden follicular lymphoma ltbfl was established in an era. If you have low grade follicular lymphoma, you may not have treatment as soon as you are diagnosed. As a slowgrowing type of nhl, follicular lymphoma does. Recent trials have demonstrated improvements in progressionfree and overall survival with the inclusion of the chimeric anticd20 monoclonal antibody rituximab rituxan in chemotherapy regimens for treatmentnaive and relapsed patients with advancedstage follicular nonhodgkins lymphoma nhl. Overview lenalidomide with rituximab for previously. Rituximab more costeffective than watch and wait for. Watch and wait, watch and worry, or watch and live. Your follicular lymphoma journey begins with initial treatment. Rituximab maintenance improved longterm survival in. Patients with follicular lymphoma often will notice an area of painless swelling on the body, such as on the neck, underarm or groin. Influence of the watch and wait strategy on clinical outcomes of patients with follicular lymphoma in the rituximab era. If patients show no or very few symptoms, physicians may recommend not to treat the disease right away, an approach referred to as active surveillance watch and wait.
Patients with low tumor burden follicular lymphoma have been studied in studies such as rituximab vs watch and wait or. In an analysis of a wellcharacterized dataset capturing outcomes for patients with asymptomatic, lowburden follicular lymphoma, those managed by initial watchful waiting had outcomes similar to comparable patients who were treated at the time of diagnosis with regimens including rituximab. Watchful waiting for patients with follicular lymphoma. Rituxan rituximab for follicular lymphoma treatment.
The goal in using this combination of drugs is to keep your cancer from getting worse. Rituximab versus a watch andwait approach in patients with advancedstage, asymptomatic, nonbulky follicular lymphoma. These irregular shaped follicles replace the normal structure of a lymph node. For decades, clinical trials unsuccessfully pitted various chemotherapy combinations against each other. Rituximab versus a watchandwait approach in patients with advancedstage, asymptomatic, nonbulky follicular lymphoma. What is the role of maintenance rituximab in follicular.
Rituximab instead of watch and wait in asymptomatic. In this study, we show that in patients with asymptomatic advancedstage lowtumourburden follicular lymphoma, immediate treatment with rituximab monotherapy significantly delays disease progression and the time until chemotherapy or radiotherapy compared with a watchful waiting approach. Right now, we have randomized studies in the frontline setting for patients with untreated follicular lymphoma, who are of high tumor burden, looking at rsquared, or lenalidomide plus rituximab. This means that the lymphoma usually grows quite slowly, over a number of years. Frontline therapy with rituximab added to the combination of cyclophosphamide, doxorubicin, vincristine, and prednisone chop significantly improves the outcome for patients with advancedstage follicular lymphoma compared with therapy with chop alone. Progressionfree survival after maintenance rituximab.
Treatment of relapsed or refractory follicular lymphoma. Follicular lymphomas fl has been traditionally approached either by an initial watch and wait policy in the asymptomatic patient, or with single agent treatments with the purpose of maintaining a good quality of life for a prolonged time. The most common antibodies used are rituximab brand name. Sustained progressionfree survival benefit of rituximab. The term refractory is used to describe when the lymphoma does not respond to treatment or when the response to treatment does not last very long. Follicular lymphoma is the most common sub type of low grade indolent lymphoma, making up 2030% of all nonhodgkin lymphomas. Follicular lymphoma initial treatment rituxan rituximab. Treatment options there are various treatment options for fl based on the severity of associated symptoms and the rate of cancer growth. Rituximablenalidomide potential frontline therapy for. As rituximab therapy has significant singleagent activity in follicular nhl, is. There are no published trials evaluating rituximabchemotherapy combinations and just a few.
Outcomes for transformed follicular lymphoma in the rituximab era. It took but a single, noncytotoxic molecule, rituximab rituxan, to forever alter the landscape. Bc cancer protocol summary for the treatment of lymphoma. Pdf follicular lymphoma fl is the second most common type of. June 6, 2017 follicular lymphoma fl, which accounts for about 20% to 30% of all nonhodgkin lymphomas, is an incurable disease. Rituximab versus a watchandwait approach in patients. December 5, 2010 orlando, florida patients with asymptomatic nonbulky follicular lymphoma are generally followed with a wait and watch approach and. The cancer originates from the uncontrolled division of specific types of bcells known as centrocytes and centroblasts. Gazyva, which selectively target follicular lymphoma tumor cells. The f2study is the updated follicular lymphoma international prognostic index flipi.
This study addresses an important clinical question for patients with an incurable yet often indolent diseaseshould cancerdirected treatment begin sooner or later if the cancer cannot be cured. We can say that the natural evolution of follicular lymphoma has been modified along with the introduction of immunotherapy. Immunotherapy with rituximab in follicular lymphomas. I will do more research on the rituxan maintenance program recommended by my oncologist. B patients who did, or did not, ever receive rituximab. One on my right shoulder, one on in my neck and two on my chest. Most follicular lymphoma cells have a specific chromosomal abnormality a translocation between parts of chromosomes 14 and 18 that causes the production overexpression of the gene, bcl2, which can make the. As initial treatmentrituxan, with cvp chemotherapy, may be given to treat follicular lymphoma. For older people who have symptoms but have no evidence of organ dysfunction, treatment with rituximab alone may be recommended. Understanding the indolent lymphomas december 8, 2012. The term relapsed refers to disease that reappears or grows again after a period of remission. Follicular lymphoma is a bcell lymphoma characterised by tumour cells that appear in a circular, or clumplike, pattern under the microscope. It was done in the postrituximab era, whereas flipi was done in the prerituximab era.
Rituximab maintenance therapy is feasible and leads to good survival rates among elderly patients with follicular lymphoma fl, according to a study published in. The addition of rituximab has been shown to increase median survival rates among some patients with nonhodgkin lymphoma. A randomized phase iii trial comparing watchful waiting with firstline rituximab for advanced stage follicular lymphoma commenced in japan in december 2016. Rituximab monotherapy should be considered as a treatment option for patients with asymptomatic, advancedstage, lowtumourburden follicular lymphoma. Follicular lymphoma is the most common type of indolent slowgrowing nhl. Since it is a slowmoving cancer, it may not need immediate treatment. National institute for health and clinical excellence. After fourth round and a pet scan, doctor diagnosed me as being in 100% remission. The distinction between low tumor burden and high tumor burden is relevant because clinical trials often distinguish between such patients in terms of the appropriateness of certain therapies see. Download citation rituximab for follicular lymphoma treatment with the chimeric anticd20 antibody rituximab has been rapidly accepted into the clinical treatment of patients with cd20.
Rituximab monotherapy in follicular lymphoma cll nhl. The roadside along the path to curing follicular lymphoma is riddled with the debris of failed cytotoxic regimens. After 120 weeks, the rituximablenalidomide combination, known as r 2, showed a complete remission cr or unconfirmed cr rate of 48% compared with. The combination of rituximab and ibrutinib has been tested in clinical trials and appeared to be well tolerated and active. There are various treatment options for fl based on the severity of associated symptoms and the rate of cancer growth. Sustained progressionfree survival benefit of rituximab maintenance in patients with follicular lymphoma. Maintenance rituximab improves follicular lymphoma. Rituximab plus chemotherapy followed by maintenance therapy with rituximab has been shown to be effective in patients with advanced follicular lymphoma for whom treatment is indicated, with median. One randomized clinical trial has compared singleagent rituximab to watch and wait in patients with previously untreated, asymptomatic, lowtumorburden fl. Follicular lymphoma fl is the second most common nonhodgkins lymphoma nhl in the western world, representing 20% to 30% of all nhl cases and an annual incidence of 5100,000.
Patients must receive first dose by iv infusion using the iv formulation because the risk of reactions is highest with the first infusion. Pdf rituximab in the treatment of follicular lymphoma. Follicular lymphoma responds well to treatment, but it is difficult to cure. These cells normally occupy the follicles nodular swirls of various types of lymphocytes in the germinal centers of lymphoid tissues such as lymph nodes. Follicular lymphoma fl is the second most common subtype of nonhodgkin lymphoma nhl, making up about 22 percent of all nhl cases. Controversies in the treatment of follicular lymphoma.
441 177 484 1098 947 190 1033 806 1207 465 1247 909 935 1466 1028 542 573 754 1368 1028 406 397 1384 90 322 29 1513 1079 934 1411 358 1375 1046 577 1191 1426 1013 810 17