A recent study examined three different follicular lymphoma (FL) patients to try to better understand how the disease presents differently for different individuals.

Ultimately, this study has reiterated the importance of individualized treatments for patients, and specifically, high-risk patients.

Case 1

Age: 56, Sex: Female

This first patient had high risk features. They were prescribed obinutuzumab chemotherapy (G) because it would provide the longest time until the next treatment was needed. This decision was based off the Gallium study which showed that four year progression-free survival was better for this therapy than for rituximab chemotherapy (R).

Case 2

Age: 72, Sex: Male

The second patient faced comorbidities in addition to his FL which made it difficult to come up with treatment options. For example, he had a heart condition which means he was not able to take CHOP.

This patient was treated with R-bendamustine as G had not yet been approved. Unfortunately, he suffered Pneumocystis jiroveci pneumonia (PJP) following this treatment. Researchers believe he could have benefited from G. They also discussed that if the antibody were changed, toxicity may have been reduced by reducing the intensity of chemotherapy. For instance, G plus GVP.

Case 3

Age: 68, Sex: Male

The third patient also had prostate cancer. Thankfully, this cancer was localized. He was treated with R-CHOP but unfortunately, after he reached maintenance, he experienced a relapse. The patient refused ASCT as a second therapeutic choice. Instead, he was given G-bendamustine. This was chosen from the GADOLIN study.

This case led the researchers to discuss the worse prognosis of patients who relapse early. Of course, this also documents the essential need to more accurately pinpoint which patients are at greater risk of such. Patients who relapse early are difficult to treat, and improving treatment from the get-go can improve outcomes.

What They Learned

These case studies have shown that treatment decisions have to be made by weighing a patient’s risk factors, comorbidities, and personal preferences. The risks and benefits of each treatment option for each individual patient must be evaluated. This way, researchers can choose the right treatment that a patient needs at the time they need it. There is no one size fits all, even for high risk FL patients. Patients are individuals and need to be evaluated as such.