title: Emerging therapies for the treatment of relapsed or refractory follicular lymphoma.
abstract: With no treatment standard having been established for relapsed and refractory follicular lymphoma, a number of therapeutic approaches are used in Canada. In patients who relapse early or who eventually become resistant to subsequent treatment, prognosis is poor, and new approaches are needed. A number of novel therapies are being examined in this setting, including monoclonal antibodies, immunoconjugates, immunomodulatory agents, and signal transduction inhibitors. With the body of evidence for those emerging therapies accumulating and the standard upfront treatment changing from rituximab and chop (cyclophosphamide-doxorubicin-vincristine-prednisone) or rituximab and cvp (cyclophosphamide-vincristine-prednisone) to bendamustine and rituximab, treatment decisions in the relapsed and refractory setting have become more complex. The choice of subsequent treatment must consider type of upfront treatment; duration of remission; and patient-related factors such as age, comorbidities, and treatment preferences. This paper summarizes the evidence for novel therapies and proposes recommendations for subsequent treatment options by remission duration after induction and maintenance.
authors.affiliation: Division of Hematology, Dalhousie University, and QEII Health Sciences Centre, Halifax, NS.
authors.forename: D
authors.initials: D
authors.lastname: MacDonald
authors.affiliation: Department of Medical Oncology, University of Toronto, and Princess Margaret Hospital, Toronto, ON.
authors.forename: A
authors.initials: A
authors.lastname: Prica
authors.affiliation: Department of Oncology, McGill University, and Jewish General Hospital, Montreal, QC.
authors.forename: S
authors.initials: S
authors.lastname: Assouline
authors.affiliation: impact Medicom Inc., Toronto, ON.
authors.forename: A
authors.initials: A
authors.lastname: Christofides
authors.affiliation: Hoffmann-La Roche, Mississauga, ON.
authors.forename: T
authors.initials: T
authors.lastname: Lawrence
authors.affiliation: Division of Medical Oncology, University of British Columbia, and BC Cancer Agency, Vancouver, BC.
authors.forename: L H
authors.initials: LH
authors.lastname: Sehn
keywords: Follicular lymphoma; emerging therapies; novel treatments; refractory disease; relapsed disease