title: Follicular lymphoma: evolving therapeutic strategies.
abstract: Follicular lymphoma (FL) is the most common indolent non-Hodgkin lymphoma in the Western hemisphere. After decades of stagnation, the natural history of FL appears to have been favorably impacted by the introduction of rituximab. Randomized clinical trials have demonstrated that the addition of rituximab to standard chemotherapy induction has improved the overall survival. Maintenance rituximab strategies can improve progression-free survival. Even chemotherapy platforms have changed in the past 5 years, as bendamustine combined with rituximab has rapidly become a standard frontline strategy in North America and parts of Europe. Recent discoveries have identified patients at high risk for poor outcomes to first-line therapy (m7-Follicular Lymphoma International Prognostic Index [m7-FLIPI]) and for poor outcomes after frontline therapy (National LymphoCare Study). However, several unmet needs remain, including a better ability to identify high-risk patients at diagnosis, the development of predictive biomarkers for targeted agents, and strategies to reduce the risk of transformation. The development of targeted agents, exploiting our current understanding of FL biology, is a high research priority. A multitude of novel therapies are under investigation in both the frontline and relapsed/refractory settings. It will be critical to identify the most appropriate populations for new agents and to develop validated surrogate end points, so that novel agents can be tested (and adopted, if appropriate) efficiently.
authors.affiliation: Division of Oncology, Washington University School of Medicine, St. Louis, MO; and.
authors.forename: Brad S
authors.identifier: 0000-0003-0459-6609
authors.initials: BS
authors.lastname: Kahl
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine, Madison, WI.
authors.forename: David T
authors.identifier: 0000-0002-9488-1704
authors.initials: DT
authors.lastname: Yang
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016175:B-Lymphocyte Subsets / Q000378:metabolism / Q000473:pathology; D019468:Disease Management; D019254:Genes, bcl-2; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D008224:Lymphoma, Follicular / Q000188:drug therapy* / Q000453:epidemiology / Q000235:genetics / Q000473:pathology; D008954:Models, Biological; D058990:Molecular Targeted Therapy; D009363:Neoplasm Proteins / Q000235:genetics / Q000502:physiology; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D000069283:Rituximab / Q000008:administration & dosage; D012641:Selection, Genetic; D059467:Transcriptome; D014178:Translocation, Genetic; D016896:Treatment Outcome; D047368:Tumor Burden; D059016:Tumor Microenvironment; D060152:V(D)J Recombination
chemical_list: D007155:Immunologic Factors; D009363:Neoplasm Proteins; D000069283:Rituximab