What are the nccn treatment guidelines for follicular. Follicular lymphoma fl is the most common subtype of indolent lymphomas. Abstract disease overview follicular lymphoma is generally an indolent b cell. Lenalidomide is an immunomodulatory drug approved in the united states for use with rituximab in patients with relapsedrefractory follicular lymphoma.
Several lines of evidence suggest that the prognosis of patients with fl has. Follicular lymphoma is an incurable disease for which patients are in need of a safe, durable treatment option, said dr. Fl is generally very responsive to radiation and chemotherapy. Follicular lymphomas are the second most frequent subtype of nodal lymphoid malignancies in western europe. What are the nccn treatment guidelines for follicular lymphoma. Aug 23, 2018 please use one of the following formats to cite this article in your essay, paper or report. Nonhodgkin lymphoma i page 1 table of contents 2 introduction 4 here to help 7 nonhodgkin lymphoma overview 9 incidence, causes and risk factors 11 signs and symptoms 12 diagnosis 14 staging 17 treatment overview 22 treatmentaggressive subtypes, part 1 25 treatmentaggressive subtypes, part 2 27 treatmentindolent subtypes. Jan 14, 2020 follicular lymphoma is a common type of nonhodgkin lymphoma nhl.
Follicular lymphoma is the second most frequent nonhodgkin lymphoma accounting for about 1020% of all lymphomas in western countries. Clinical features, prognosis and treatment of follicular lymphoma. There is no evidence to support a different treatment approach between grade 1 and grade 2 fl. New treatment options for patients with follicular lymphoma. Obinutuzumab for the firstline treatment of follicular.
It is the most common of the clinically indolent nhls defined as those lymphomas in which survival of the untreated patient is measured in years. If you do need treatment, it may include one or more. The national comprehensive cancer network recommends cancer patient participation. Nonhodgkin lymphoma i page 1 table of contents 2 introduction 4 here to help 7 nonhodgkin lymphoma overview 9 incidence, causes and risk factors 11 signs and symptoms 12 diagnosis 14. Follicular lymphoma is a cancer that develops in the white blood cells, lymphatic system and bone marrow. Hodgkin lymphoma nhl in western countries, with an annual incidence of 3. These regimens are provided only to supplement the latest treatment strategies. Epidemiology prevalence of follicular lymphoma is estimated at about,000. Lenalidomide in follicular lymphoma blood american. Follicular lymphoma grade 12 part 1 of 3 clinical trials.
If approved, we believe tazverik could become an important new option for these patients and their physicians. But, since follicular lymphoma grows slowly, it often does not require treatment in the initial stage. Treating nonhodgkin lymphoma american cancer society. Jan 01, 2020 the standard treatment for hodgkin lymphoma is abvd doxorubicin adriamycin, bleomycin, vinblastine velban, and dacarbazine, but other regimens such as the stanford v doxorubicin. Its a cancer of the lymph tissue, an important part of the immune system. Follicular lymphoma fl is a common type of nonhodgkins lymphoma nhl, accounting for 22% to 35% of nhl in western countries. May 08, 2020 the 2016 who classification includes three variants of follicular lymphoma. Follicular lymphoma grade 12 part 2 of 3 firstline therapy for elderly or infirm if none of the above are expected to be tolerable 1 regimen dosing rituximab preferred 811 day 1. Dec 05, 2011 follicular lymphoma is the second most frequent nonhodgkin lymphoma accounting for about 1020% of all lymphomas in western countries. Follicular lymphoma is one of the most common types of nonhodgkin lymphoma, or nhl it is a slowgrowing lymphoma, and often its not immediately life threatening.
Chemo is the main treatment for most people with nonhodgkin lymphoma nhl. Therefore, the treatment of follicular lymphoma has now shifted from chemotherapy alone to starting treatment with a combination of chemotherapy and immunotherapy. Diffuse large bcell lymphoma cases with an irf4 translocation were significantly more frequent in children than in adults with diffuse large bcell lymphoma or follicular lymphoma in one report 15% vs. This document is provided by the anticancer fund with the permission of esmo.
Rituximab is an anticd20 monoclonal antibody with established activity in follicular lymphoma. Follicular lymphoma is a slowgrowing disease exhibiting a heterogeneous clinical course, with a subset of patients experiencing a rapid disease course in the first two years and some developing. Zevalin treatment is chemofree for relapsed patients and is a shortcourse therapythe entire treatment regimen can be completed in less than 10 days. Lymphoma occurs when cells of the immune system called lymphocytes, a type of white blood cell, grow and multiply uncontrollably.
Patients remained on treatment for a median duration of 22 weeks, during which time they. In this primer, carbone and colleagues discuss the epidemiology, mechanisms and the recent. My latest pet scan showed only 1 % of the lymphoma left. Treatment strategies in limited stage follicular lymphoma approximately 1020% of fl patients present in limited stages iii and half of them could enjoy durable remission after treatment with involved field radiation therapy rt. Although fl is considered incurable with standard chemotherapy, advances in treatment and our understanding of its biology have improved disease management and clinical outcomes. An overview of follicular lymphoma verywell health. The combination of the anticd20 monoclonal antibody rituximab with chemotherapy has significantly improved outcomes in patients. Over time, 30% to 40% of follicular lymphomas behave like or turn into other forms of lymphoma that grow faster and need intensive treatment. Follicular lymphoma grade 1, 2 part 1 of 3 the selection, dosing, and administration of anticancer agents and the management of associated toxicities are complex. The 2016 who classification includes three variants of follicular lymphoma. Based on the updated national comprehensive cancer network guidelines and related. Follicular lymphoma fl is a common subtype of bcell lymphoma. Follicular lymphoma fl is the most common indolent nonhodgkin lymphoma nhl in the western hemisphere. Mar 01, 2010 follicular lymphoma is a form of nonhodgkin lymphoma see this term characterized by a proliferation of b cells whose nodular structure of follicular architecture is preserved.
Follicular lymphoma constitutes the most frequent indolent lymphoma, well characterized by its clinical presentation related to nodal involvement and its. Improvements in observed and relative survival in follicular grade 12 lymphoma during 4 decades. Less than 20 percent of patients present with b symptoms and also less than. Guidelines for the diagnosis and treatment of follicular. Follicular lymphoma is also called an indolent or lowgrade lymphoma for its slow nature, both in terms of its behaviorslower growthand how it looks under the. Follicular lymphoma is a welldefined subtype of nonhodgkin lymphoma nhl with cells of. In some cases, it might not cause any symptoms until it grows quite large. In the united states in 20, about 9,290 persons were expected to be diagnosed with hodgkin lymphoma. Follicular lymphoma is located primarily in the lymph nodes, but can also involve the spleen, bone.
Treatment for follicular lymphomatreatment option for follicular lymphoma is determined by displayed symptoms, tumor grade, patients age and overall health. The information in this document does not replace a medical consultation. Follicular lymphoma grade 1, 2 part 1 of 3 the selection, dosing, and administration of anticancer agents and the management of associated. Common symptoms of follicular lymphoma are painless swelling of the lymph nodes. Optimizing firstline therapy for follicular lymphoma. Relapsedrefractory overview lymphoma is the most common blood cancer. Pdf follicular lymphoma fl is a heterogeneous disease with varying prognosis owing to differences in clinical, laboratory, and disease. Follicular lymphoma fl is the second most common type of nonhodgkin lymphoma nhl. Lymphoma is a general name for a group of cancers that affect the lymphatic system. The annual incidence of this disease is rare but has increased during recent decades. Follicular lymphoma is the most common type of indolent, or slowgrowing, nonhodgkins lymphoma. It is important to note that lymphoma also represents the most commonly diagnosed nonepithelial cancers in adolescents and young adults in canada. Follicular lymphoma is affecting mainly adults and rarely seen in patients aged dec 12, 2019 follicular lymphoma is an indolent malignancy composed of transformed follicular germinal centre b cells. The two main forms of lymphoma are hodgkin lymphoma hl and nonhodgkin lymphoma nhl.
The clinical presentation is usually characterized by asymptomatic peripheral adenopathy in cervical, axillary, inguinal and femoral regions. In most cases, the cancer is diagnosed when the disease is widespread. Guidelines for the diagnosis and treatment of follicular lymphoma in. Several anticd20 monoclonal antibodies have been approved by the fda, and of these treatments, only 3 are currently approved for use as the first firstline treatment for. The standard treatment for hodgkin lymphoma is abvd doxorubicin adriamycin, bleomycin, vinblastine velban, and dacarbazine, but other regimens such as the stanford v. No sex preponderance is seen for follicular lymphomas, but the incidence increases with age and varies across racial groups. The following discussion is pertinent to the treatment of both types of childhood nhl. Follicular lymphoma is a common form of nonhodgkins lymphoma and accounts for about 15% of all cases. Patients remained on treatment for a median duration of 22 weeks, during which time they received a median of 5. Follicular lymphoma is a cancer that affects white blood cells called lymphocytes. Hodgkins and nonhodgkins, based on the kind of white blood cell they affect. Drug dose modifications and schedule and initiation of supportive care interventions are often necessary because of expected toxicities and. Unlike mature blineage nhl seen in adults, there is no difference in outcome based on histology burkitt lymphoma leukemia or diffuse large bcell lymphoma.
Radiation therapy for follicular lymphoma general center. What is the who classification of follicular lymphoma. The two major types of lymphoma are hodgkin lymphoma hl and nonhodgkin lymphoma nhl. Depending on the type 1 and the stage 2 of the lymphoma, chemo may be used alone or combined with other treatments, such as immunotherapy drugs orradiation. Between 1992 and 2005, 5577 new cases of hodgkin and nonhodgkin lymphoma were diagnosed in canadians aged 15. Rituximab plus chemotherapy followed by maintenance therapy with rituximab has been shown to be effective in patients with advanced follicular lymphoma for whom treatment is indicated, with median. Rituximab maintenance for the treatment of patients with follicular lymphoma. Follicular lymphoma fl is the most common indolent non. Follicular lymphoma treatment and prognostic factors. Follicular lymphoma tumors are graded from 1 to 3 and this grade has some prognostic utility.
Although incurable, prognosis has improved for early. Follicular lymphoma is a form of nonhodgkins lymphoma that affects bcells. There are various treatment options for fl based on the severity of associated symptoms and the rate of cancer growth. Quick take obinutuzumab for treatment of follicular lymphoma 01. Radiation alone can provide a longlasting remission disappearance. Follicular lymphoma page 5 of 12 fludarabine in combination with alkylatorbased chemotherapy also has not resulted in improved outcomes, but does cause significant toxicity 27. Nonhodgkin lymphoma nhl is generally divided into main 2 types, based on whether it starts in b lymphocytes b cells or t lymphocytes t cells. The updated esmo clinical practice guidelines on newly diagnosed and relapsed follicular lymphoma cover diagnosis, staging and risk assessment. Follicular lymphoma was the dominant lymphoma subtype, accounting for 73. Obinutuzumab for the firstline treatment of follicular lymphoma. I am doing treatment for stage 2b follicllar lymphoma. Treatment usually depends both on the type of lymphoma and the stage extent of the disease, but many other factors can be important as well.
Fda approves aliqopa for follicular lymphoma treatment. Median age of diagnosis is 65 years, but a large proportion of cases also occurs in younger adults. There has generally been suboptimal consensus of pathologists on grading fl. Epizyme announces fda acceptance of new drug application. Follicular lymphoma is a welldefined subtype of nonhodgkin lymphoma nhl with cells of the lymphoid tissues in the lymphatic system multiplying uncontrollably to eventually cause tumours to grow. Pdf diagnosis and treatment of follicular lymphoma. Epizyme announces fda acceptance of new drug application for. The updated esmo clinical practice guidelines on newly diagnosed and relapsed follicular lymphoma cover diagnosis, staging and risk assessment, treatment recommendations, innovative approaches, personalised medicine, followup and longterm implications and survivorship.
Follicular lymphoma genetic and rare diseases information. These guidelines are a work in progress that may be refined as often as new. Active treatment is started if the patient begins to develop lymphomarelated symptoms or there are signs that the disease is progressing based on testing during followup visits. Rituximab plus lenalidomide in advanced untreated follicular. Hodgkin lymphoma i page 1 table of contents 2 introduction 2 here to help 6 hodgkin lymphoma 7 incidence, causes and risk factors 8 signs and symptoms 9 diagnosis 10 subtypes of hodgkin.
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