Follicular Lymphoma: Therapy Sequencing in Relapsing/Remitting Disease

In a video conversation recorded for Cancer Network, Kristie L. Kahl and Javier L. Munoz, MD, MS, FACP discussed treatment for relapsing/remitting follicular lymphoma and the importance of the sequencing of different therapies, or the order in which different treatments may be tried with a given patient. As most patients with this cancer will often deal with one if not multiple relapses, this has important implications for this patient population.

About Follicular Lymphoma

Follicular lymphoma is a type of blood cancer. While generally considered rare, it is the most common type of slow-growing non-Hodgkin’s lymphoma. This cancer affects follicle center B-cells, which are also known as centrocytes. There appears to be a genetic basis for follicular lymphoma, and the cancer has been linked to translocation between chromsomes 14 and 18. This results in the overexpression of a gene called bcl-2. Symptoms for this cancer are similar to other blood cancers, such as night sweats, fever, infections, weight loss, swollen lymph nodes, shortness of breath, and fatigue. Treatment options may include monoclonal antibodies, chemotherapy, radioimmunotherapy, and stem cell transplant. Some patients can survive for decades with follicular lymphoma, with a median survival time of 10 years. The five-year survival rate is 72 to 77 percent. With the newest treatments, survival rates are improving. To learn more about follicular lymphoma, click here.

One of the more recently approved therapies for this disease is called tazemetostat, which has several benefits for patients as it is an orally available option that does not have the side effects of other treatments such as chemotherapy. In fact, levels of grade three or higher level toxicity are very low.

Dr. Munoz says that therapy sequencing has become more difficult as more options have become available, and typically remission periods get shorter with each subsequent treatment. Sequencing is often dependent on the characteristics of a patient’s disease and the case overall, and no universal preferred guidelines have been established. Dr. Munoz tries to avoid chemotherapy and focus on oral treatments, which gives patients more time at home.

In patients who have not had durable remissions, Dr. Munoz also considers CAR T-cell therapy in patients that have the ability to tolerate it, as it can carry strong adverse effects but is also a useful option. He also actively encourages patients to enroll in a clinical trial if they are beginning to run low on options.

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