title: Individualized management of follicular lymphoma.
abstract: Follicular lymphoma (FL) is the most common indolent non-hodgkin lymphoma. Most patients with FL are diagnosed with advanced disease and are considered incurable. The classical prognostic index in FL is the FL international prognostic index (FLIPI). The management of FL is mainly determined by histologic grading, clinical stage, and tumor burden. For patients with stage I and II disease, an involved-site radiation therapy (ISRT) is recommended and may be potentially curative approach with 60% to 80% of 10-year overall survival (OS) rates, while patients with stage III and IV should be treated with systemic therapy. The watchful waiting is still an option for patients without symptoms or/and low tumor burden. Induction of immuno-chemotherapy combined with consolidation of rituximab maintenance (MR) is standard care for patients with symptomatic disease or with high tumor burden when treatment indicated. The major indication for systemic therapy is including candidate for clinical trials, threatened end organ function, cytopenia secondary to lymphoma bulky disease and steady progress etc. at present time. Routine baseline and regular hepatitis B surface antigen (HBsAg) and hepatitis B core antibody (HBcAb) testing is strongly recommended for all patients before the initiation of immuno-chemotherapy in order to minimize the risk of hepatitis B virus (HBV) reactivation which has been observed approximately 20% to 50% of patients with positive HBsAg and 3% to 45% of patients with positive HBcAb. Prophylactic antiviral treatment in patients who are HBsAg-positive or HBcAb-positive is indicated before immuno-chemotherapy. The management for elderly patients should be carefully selected to avoid overtreatment and severe toxicities. Individualized dose adjustment for chemotherapy and an adequate supportive treatment are essential for this special population. Novel agents such as lenalidomide, ibrutinib and idelalisib are promising. In conclusion, individualized management of FL remains challenging and role of new targeted agents need to be defined.
authors.affiliation: Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, Sun Yat-Sen Institute of Hematology, Sun Yat-Sen University, Guangzhou 510275, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Bai
authors.affiliation: Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, Sun Yat-Sen Institute of Hematology, Sun Yat-Sen University, Guangzhou 510275, China. huanghq@sysucc.org.cn.
authors.forename: Hui-Qiang
authors.initials: HQ
authors.lastname: Huang
mesh_terms: D000367:Age Factors; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use; D006509:Hepatitis B / Q000188:drug therapy / Q000276:immunology; D006515:Hepatitis B virus / Q000187:drug effects / Q000276:immunology; D006801:Humans; D008224:Lymphoma, Follicular / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D058990:Molecular Targeted Therapy; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D018579:Patient Selection; D011237:Predictive Value of Tests; D011878:Radiotherapy / Q000009:adverse effects; D012307:Risk Factors; D033581:Stem Cell Transplantation / Q000009:adverse effects / Q000401:mortality; D016896:Treatment Outcome; D014775:Virus Activation / Q000187:drug effects; D057832:Watchful Waiting
chemical_list: D000970:Antineoplastic Agents; D000998:Antiviral Agents
keywords: Follicular lymphoma (FL); lymphoma and immuno-chemotherapy; non-Hodgkin lymphomas (NHL); rituximab