follicular lymphoma treatment

Follicular lymphoma (FL) is one of the most common types of non-Hodgkin lymphoma (NHL). This is a slow-growing lymphoma that is usually not immediately life-threatening. Because it grows slowly and is inconspicuous, most people won’t be aware of any problems when the disease is in its early stages. By the time the disease is diagnosed, most patients (80-85%) have extensive disease, often involving many areas of lymph nodes, bone marrow, spleen, or other organs.

Slow growth, but difficult to cure completely

Even in advanced stages, people with FL can often survive for many years with standard treatments due to its slow-growing nature. However, the disease is incurable. Most people respond well to treatment, and the disease can stabilize within a few years before recurring and requiring further treatment. Many patients require multiple treatments, and the interval between stable disease after each treatment can last from months to years.

Few people are lucky enough to be diagnosed when the disease is still in its early stages. These people can usually be cured. Radiation therapy is usually used as monotherapy. Moderate doses of radiation to affected areas of the body in patients with localized disease have been seen to permanently control the disease. There is no added benefit to adding chemotherapy or biologics.

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Treatment depends in part on stage

For staging purposes, various tests can be performed, including:

  • blood test
  • Bone marrow biopsy – taking a small tissue sample from the bone marrow
  • Computed tomography or CT scan
  • Positron emission tomography or PET scan

Staging refers to the extent of transmission. Different staging systems have been used, but here is a commonly used one, which has four stages:

  • Stage I – involves only one lymph node area, or only one structure.
  • Stage II – Two or more lymph node regions or structures on the same side are involved.
  • Stage III – Involves lymph node regions or structures on both sides.
  • Stage IV – Extensive involvement of many organs or tissues other than lymph node areas or structures, such as the bone marrow.

About 15% to 20% of FL patients have stage II or I disease at diagnosis.

More than 40% have stage IV disease at diagnosis.

Grading refers to how aggressive the FL looks based on microscopic features. FL can be classified as grade 1, grade 2, or grade 3, with grade 3 being the most controversial in terms of its significance to the outcome.

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treatment method

Typically, FL grows slowly and lacks aggressive features. Treatment decisions, as well as the choice of first-line therapy, can be influenced by many factors, including a person’s clinical trial candidacy, overall health, and how the disease manifests. The specific preferred treatment approach may vary from individual to individual and for different types of FL, or even for two individuals with the same type of FL.

According to the 2019 National Comprehensive Cancer Network (NCCN) guidelines, in some cases, observation rather than treatment may be appropriate. When it comes to treatment, the NCCN guidelines include a variety of options for different situations with regard to preferred treatment. Using bendamustine plus rituximab is one such option. Radiation therapy may also play a role. In fact, stage I FL can be treated with radiation therapy alone.

The treating physician may recommend alternatives to the preferred treatment based on expectations about how well a person will tolerate a particular treatment.

Treatment options typically include the following:

  • Active monitoring
  • chemotherapy in pill form
  • Infusion chemotherapy
  • Chemotherapy and Biotherapy
  • bone marrow or stem cell transplant
  • radioimmunotherapy
  • Immunotherapy, such as monoclonal antibody therapy, immunomodulators, kinase inhibitors, and chimeric antigen receptor (CAR) T cell therapy
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How is treatment decided?

Treatment is determined based on many different factors, including treatment goals and the presence of disease symptoms. Guidelines from the National Comprehensive Cancer Network offer a variety of different FL treatments at different stages, however, different institutions may follow different practices and also address patient wishes and goals.

How does Gazyva treat follicular lymphoma?

Gazyva is a monoclonal antibody that has gained attention for its use in FL. “Despite receiving Rituxan-containing regimens, patients with follicular lymphoma who have relapsed or advanced disease need more options because the disease relapses with each recurrence,” said Sandra Horning, MD, Chief Medical Officer and Global Head, Genentech. will become more difficult to treat.” Product Development. “Gazyva plus bendamustine provides a new treatment option that can be used after relapse to significantly reduce the risk of progression or death.”

The Food and Drug Administration’s (FDA) approval of Gazyva is based on results from the Phase III GADOLIN study, which showed that in patients with FL who had disease progression during or within six months of prior Rituxan-based therapy, Gazyva plus bendamus Gazyva alone reduced the risk of disease progression or death (progression-free survival, PFS) by 52% compared with bendamustine alone.