According to a recent article, the 2021 American Society of Hematology (ASH) Annual Meeting and Exposition displayed the advances that have been made in the management of follicular lymphoma.
Follicular Lymphoma
Follicular lymphoma is a form of non-Hodgkin’s lymphoma, which is a cancer of the lymphatic system.
The lymphatic system is a part of the immune system and a complex series of thin vessels, like blood vessels, that run throughout the body. Lymph vessels carry a clear liquid called lymph that contains a type of white blood cell (lymphocyte). The lymphatic system also contains lymph nodes, the spleen, thymus, and tonsils. Follicular lymphoma usually occurs in many lymph nodes throughout the body, as well as in bone marrow.
Follicular lymphoma is a slow-growing (indolent) cancer, although in rare cases it may grow quickly. About one in five lymphomas in the U.S. is follicular lymphoma. On average, it is most likely to occur in people around age 60. It is very rare in young people.
Symptoms:
Since this cancer is slow-growing, patients will often not show obvious symptoms at the time of diagnosis. Symptoms include:
- Swollen lymph nodes in the neck, abdomen, underarms, and/or groin
- Fatigue
- Shortness of breath
- Weight loss
- Night sweats
- Fever
Some patients may eventually develop a transformed lymphoma, which is more aggressive than a follicular lymphoma.
Cause:
Follicular lymphoma arises from a type of cell called B-lymphocytes (B cells), which make them a B-cell lymphoma. B cells fight infection by creating antibodies that neutralize invaders. When those B cells develop a mutation in their DNA, the mutation tells the cells to grow abnormally, divide too rapidly, and live too long. This causes many abnormal B cells to accumulate in the lymphatic system, where they crowd out healthy cells. This compromises the body’s ability to fight infection and is what causes the symptoms of the disease.
ASH Conference 2021
The conference took place last year from December 11th to December 14th. The event was teeming with educational content and scientific abstracts on hematology subjects. In particular, there were a number of presentations that specifically focused on advances that have been made in treating and managing relapsed and refractory follicular lymphoma.
Connie Lee Batlevi’s Insights
Connie Lee Batlevi, MD, PhD, and a medical oncologist and clinical researcher at the Memorial Sloan Kettering Cancer Center in New York City, attended the ASH conference and explained what the new developments actually mean.
Batlevi talked about the use of glofitamab and how its use has shown promising results when used to treat relapsed or refractory follicular lymphoma. Glofitamab is a T-cell-engaging bispecific antibody, and it works by bringing immune effector cells to lymphoma cells and then inducing an immune response. In the end, the overall response rate of patients who used glofitamab in addition to obinutuzumab monotherapy cohort was 81% and those who used the combination therapy cohort was 100%. These results show a lot of promise according to Batlevi.
Furthermore, Batlevi discussed the study that looked at the bispecific antibody mosunetuzumab to treat follicular lymphoma and how it is different from glofitamab. She admits that there are not a lot of glaring differences between the two, however, mosunetuzumab has shown to have a slightly reduced overall response rate for reasons that are unknown. Overall, the drugs are basically equivalent options.
The conference also presented information regarding the study that looked at tisaenlecleucel as a treatment option. CAR T-cell therapy is an immunotherapy option that takes T cells and genetically modifies them to recognize lymphoma before reinfusing them into the patient after lymphodepleting chemotherapy. Tisagenlecleucel is one of the CAR T-cell therapies used in the study, as well as axicabtagene ciloleucel and lisocabtagene maraleucel. All three proved to have similar responses when used to treat follicular lymphoma. This treatment has the possibility to stabilize a patient’s disease and even get them into remission.
Finally, Batlevi spoke about the PI3K inhibitor parasaclisib. Batlevi says that parasaclisib is neither successful nor unsuccessful in treating follicular lymphoma. Some of its rates are promising, but there are still adverse effects that come along with it. She believes this might work better when combining immunotherapies with these molecular targeted therapies.
When asked what she believed was the most clinically impactful presentation at the 2021 ASH Conference, Batlevi said the data about bispecific antibodies was. She chose this as the most important since the treatments can be done earlier and even quicker in the near future. Plus, there is the possibility of combining these drugs with chemotherapy. All of these possibilities are to be looked at in the next year or so.
