title: Is There a Best Initial Treatment for a New Patient With Low Grade Follicular Lymphoma.
abstract: The treatment landscape for newly diagnosed follicular lymphoma (FL) has dramatically changed over the past decade, first with the advent of rituximab and then with the activity of old and new drugs, like bendamustine and lenalidomide, in this disease. The efficacy and tolerability of rituximab has led to a paradigm shift for the management of patients with low volume FL for many oncologists. Despite the lack of a survival benefit seen with this approach, many now use this single agent in patients who had historically been observed. Likewise, its use as maintenance therapy following successful front-line induction therapy of patients with symptomatic FL, with either rituximab alone or specific chemoimmunotherapy regimens, has improved remission duration and widely been adopted. As newer chemoimmunotherapy regimens, like bendamustine and rituximab, have superior outcomes with improved tolerability, upfront treatment options are redefined and questions emerge: whom do maintenance strategies benefit, and what is the optimal sequencing of therapies? Finally, as newer targeted and potentially better tolerated therapies demonstrate efficacy in the relapsed setting, their use, both in combination with and in place of chemotherapy, is being explored. The promising regimen of lenalidomide with rituximab is being compared with chemoimmunotherapy in a randomized fashion. Cure remains elusive, however, in advanced stage disease and so safety and tolerability, in addition to efficacy, remain important endpoints.
authors.affiliation: Department of Hematologic Malignancies, Division of Medical Oncology and Department of Medicine, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave, Boston, MA, 02215, USA. cajacobson@partners.org.
authors.forename: Caron A
authors.initials: CA
authors.lastname: Jacobson
authors.affiliation: Department of Hematologic Malignancies, Division of Medical Oncology and Department of Medicine, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave, Boston, MA, 02215, USA.
authors.forename: Arnold S
authors.initials: AS
authors.lastname: Freedman
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000069461:Bendamustine Hydrochloride / Q000627:therapeutic use; D003131:Combined Modality Therapy; D006801:Humans; D000077269:Lenalidomide; D008224:Lymphoma, Follicular / Q000188:drug therapy* / Q000473:pathology / Q000628:therapy; D016499:Radioimmunotherapy; D000069283:Rituximab / Q000627:therapeutic use*; D033581:Stem Cell Transplantation; D013792:Thalidomide / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D000069283:Rituximab; D013792:Thalidomide; D000069461:Bendamustine Hydrochloride; D000077269:Lenalidomide
keywords: Follicular lymphoma; Initial therapy