Overview of follicular lymphoma treatment

This review discussed the treatment of follicular lymphoma (FL). 

FL is a cancer of B cells, a type of white blood cell. FL is one of the most common forms of lymphoma. FL is a slow-growing, painless (indolent) cancer that does not always need immediate treatment. Over time, FL can grow more quickly or transform into a more aggressive type of lymphoma. It is important to review treatment options based on stage and risk of FL.

Roughly 10% of patients are diagnosed when the cancer is in one area of the body (stage I/II). For these patients, the best treatment is usually radiation. Early-stage patients treated with radiation are more likely to survive FL at ten years (79% vs. 66%) or at twenty years (63% vs. 51%).

For patients with advanced disease, the treatment depends on symptoms. A large trial compared the chemotherapy medication chlorambucil (Leukeran) to observation until symptoms appeared. Over sixteen years, the survival rates were the same. The targeted antibody treatment rituximab (Rituxan) also had no advantage over observation for patients without symptoms.

Multiple trials have found that rituximab plus chemotherapy leads to better survival compared to chemotherapy alone. There are now more options available for chemotherapy medications. Bendamustine (Treanda) is as effective as regimens such as CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone). Also, bendamustine had fewer side effects. Lenalidomide (Revlimid) is a medication that can kill cancer cells and work with the immune system. 70% of patients using rituximab and lenalidomide did not have their cancer progress within 5 years.

For patients with FL which has relapsed (returned) after previous treatment, targeted antibody therapies are an option. Obinutuzumab (Gazyva) is one such treatment. 55% of patients who relapsed from previous rituximab treatment responded to obinutuzumab. Radiation is very effective for patients with symptoms related to a single disease area.

It is unclear whether stem cell transplant (SCT) is beneficial for relapsed FL. A large study found that 40% of chemotherapy-sensitive patients will have a long period of remission after SCT. However, this treatment can cause secondary cancers.

Kinases are proteins involved in signaling growth. Early studies of kinase inhibitors such as copanlisib (Aliqopa) to treat relapsed FL have been promising.

This study found that there are a variety of treatments for FL including observation, radiation, chemotherapy, and targeted therapies.