Current principles of follicular lymphoma treatment

Abstract

Over the last 10-15 years, the prognosis of patients with follicular lymphoma has improved, and for the majority of patients, follicular lymphoma is a chronic disease with ten years of overall survival of around 80%. Nevertheless, a certain subset of patients belongs to high-risk follicular lymphoma with early relapses and progressive disease, poor outcomes, and much shorter survival, and there is still no standard approach in the treatment of high-risk follicular lymphoma. Treatment of follicular lymphoma is highly heterogeneous, ranging from a ?watch and wait? strategy to intensive immunochemotherapy, and needs to be individualized to each patient. An early stage of the disease can be treated with involved-field radiotherapy, which has curative potential. Follicular lymphoma in the advanced stage is still an incurable disease. Standard first-line treatment is a combination of an anti-CD20 antibody (rituximab) and chemotherapy, followed by antibody maintenance. In relapse, treatment with novel anti-CD20 monoclonal antibody-obinutuzumab in combination with chemotherapy. The combination of lenalidomide and rituximab shows good results in patients with relapses and refractory follicular lymphoma, but also as a first-line treatment. An option for elderly patients with comorbidities is rituximab monotherapy. Autologous or allogeneic stem cell transplantation may be an option for a small group of selected patients. In the past decade development of novel targeted agents such as phosphoinositide three kinase inhibitors and immunotherapies (CD20/CD3 bispecific antibody, chimeric antigen receptor T cell therapy) demonstrate the efficiency of chemotherapy-free approach not only for relapsed/refractory patients but also in first-line treatment. A better understanding of the clinical and biological features of follicular lymphoma patients is necessary to improve treatment outcomes in the future.