Treatment of follicular lymphoma.
| Disease status | Treatment | Comment |
|---|---|---|
| Localized disease | RT | - Potentially curative (ISRT 24–30Gy) |
| - The addition of systemic therapy to RT improves PFS but not OS | ||
| Rituximab | - Radiotherapy ineligible patients | |
| CIT | - Non-contiguous, bulky disease | |
| Watch and wait | - Stable, asymptomatic patients | |
| Advanced disease | Watch and wait | - Without treatment indications (Table 1) |
| CIT± antibody maintenance | - Rituximab or obinutuzumab+(CHOP, CVP, Bebdamustine) | |
| - Maintenance improves PFS but not OS | ||
| Rituximab Lenalidomide+rituximab |
- For low tumor burden | |
| - As effective as chemoimmunotherapy | ||
| Relapsed disease | Watch and wait | - Stable, asymptomatic patients |
| Palliative RT | - 2×2Gy | |
| CIT± antibody maintenance | - Long previous remission with CIT | |
| - Non-resistant regimen | ||
| Rituximab | - For low tumor burden | |
| Lenalidomide+rituximab | - POD≤24 months after CIT | |
| PI3K inhibitors | - Double refractory disease | |
| EZH2 inhibitor (tazemetostat) | - EZH2 mutation-positive disease | |
| Radioimmunotherapy | - Not widely used | |
| Auto/allo-HSCT | - In selected patients | |
| CAR-T cell therapy | - After ≥2 lines of systemic therapy [63] |
Abbreviations: CAR-T, chimeric antigen receptor T-cell; CIT, chemoimmunotherapy; CR, complete response; EZH2, enhancer of zeste homolog 2; HSCT, hematopoietic stem cell transplantation; ISRT, involved site RT; ORR, overall response rate; OS, overall survival; PFS, progression-free survival; PI3K, phosphatidylinositol 3-kinase; POD, progression of disease; RT, radiotherapy.
Blood Res 2022;57:S120~S129 https://doi.org/10.5045/br.2022.2022054
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