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RelapsedRefractory Follicular Lymphoma and Personalized Medicine

How do you treat relapsed/refractory follicular lymphoma?

Treatment for relapsed/refractory FL is based on a patient’s age, overall health, symptoms, and the duration of remission from the last treatment they received. Chemotherapy, radiation, monoclonal antibodies, and chimeric antigen receptor (CAR) T cell therapy may be used to treat relapsed/refractory FL.

How often does follicular lymphoma relapse?

Approximately 20% of patients with follicular lymphoma will relapse within 2 years of diagnosis.

What is the latest treatment for follicular lymphoma?

The newest drug to be approved by the FDA for follicular lymphoma is Copiktra (duvelisib), an oral drug that targets PI3K-alpha, a protein that is overexpressed in many B-cell cancers, including follicular lymphoma, and encourages the growth of cancerous cells.

How common is refractory lymphoma?

Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma. Although 5-year survival rates in the first-line setting range from 60% to 70%, up to 50% of patients become refractory to or relapse after treatment.

When do you treat patients with relapsed follicular lymphoma?

Treatment for those with recurrent follicular lymphoma may be safely delayed in the absence of bulk, compressive or constitutional symptoms, cytopenias related to lymphoma or steady progression. Patients with localized relapse may be considered for radiotherapy if the involved field would result in minimal toxicity.

How quickly can lymphoma come back?

Most relapses of Hodgkin lymphoma or high-grade non-Hodgkin lymphoma happen within the first 2 years after treatment. As time goes on, relapse generally becomes less likely.

How do I know if my follicular lymphoma is back?

Typical signs of a relapse include symptoms similar to when you were diagnosed such as new rapidly growing nodes or B symptoms such as night sweats, fevers and weight loss. Relapse is most likely to happen within the first 2 years after treatment.

How do you keep follicular lymphoma in remission?

Maintenance Therapy

This is a treatment you can get once you’re in remission. Maintenance therapy involves taking medicines to kill any cancer cells that are still in your body. It helps to keep you in remission for longer.

Can you live a long life with follicular lymphoma?

Follicular lymphoma is slow-growing cancer. People diagnosed with the disease may not find a cure but can still live for a long time with it. The five-year survival rate for follicular lymphoma is 80-90% with patients surviving for a median of 10-12 years.

What is the best treatment for follicular lymphoma?

FL is generally very responsive to radiation and chemotherapy. Radiation alone can provide a long-lasting remission in some patients with limited disease. In more advanced stages, physicians may use one or more chemotherapy drugs or the monoclonal antibody rituximab (Rituxan), alone or in combination with other agents.

What is new in follicular lymphoma?

We’ve seen over the past five years, a number of new drugs approved. Really over the… Already in 2022, two new treatments approved in follicular lymphoma already. These were, more specifically, umbralisib (Ukoniq) and the CAR T-cell axicabtagene ciloleucel (Yescarta).

Can follicular lymphoma disappear?

Although follicular lymphoma usually can’t be cured, you can live long and well with it. This cancer grows slowly. You may not need treatment for many years, or ever. But if you do, it usually works well.

What is the treatment for relapsed lymphoma?

Treatment consists of high dose chemotherapy, stem cell transplant, CAR T cells and precision cancer medicines. Treatment consists of high dose chemotherapy, stem cell transplant, CAR T cells and precision cancer medicines.

What is the difference between relapse and refractory?

What are relapsed and refractory diseases? Relapsed disease means a cancer has come back. Refractory disease means a cancer has stopped responding to treatment.

How do you treat relapsed DLBCL?

Rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisone is the current frontline standard-of-care treatment for DLBCL and has been shown to cure almost 60% of cases in younger and elderly patients.

Can follicular lymphoma transform?

Transformation can happen in any type of low-grade lymphoma but it is most common in follicular lymphoma. Every year, transformation affects around 2 to 3 in every 100 people with follicular lymphoma. Other types of low-grade lymphoma transform less frequently.

What is the recurrence rate of lymphoma?

More specifically half the recurrences happen within 2 years of primary treatment and up to 90% occur before 5 years. Occurrence of a relapse after 10 years is rare and after 15 years the risk of developing lymphoma is same as its risk in the normal population.

Is stage 4 follicular lymphoma curable?

A diagnosis of stage 4 lymphoma might be difficult to accept. But it’s important to know that some types of stage 4 lymphoma may be curable. Your outlook depends, in part, on the type of stage 4 lymphoma that you have.

What happens if lymphoma comes back after stem cell transplant?

Patients with relapse of high-grade non-Hodgkin lymphoma (NHL) after autologous stem cell transplantation (auto-SCT) generally have a poor prognosis. Only a minority of these patients can be cured by a second myeloablative chemotherapy, and conventional salvage treatments are often associated with severe toxicities.

Can lymphoma come back in the same place?

If lymphoma comes back, it might be in the same area where it was before. Or it could affect another part of the body. If it causes symptoms, they may be the same as before or different.

How often does DLBCL relapse?

Background: DLBCL has a 40% relapse rate in the rituximab era. Patients who relapse within a year do poorly even with salvage treatment.

What happens when mantle cell lymphoma returns?

For relapsed mantle cell lymphoma, the stem cells usually come from a donor. This is called an allogeneic stem cell transplant. If you are young and in overall good health, your doctor might use your own stem cells, which is called an autologous stem cell transplant.

Can lymphoma come back after 10 years?

It’s very important to go to all of your follow-up appointments, because lymphoma can sometimes come back even many years after treatment. Some treatment side effects might last a long time or might not even show up until years after you have finished treatment.

What happens if chemo doesn’t work for lymphoma?

If the lymphoma doesn’t respond to the initial treatment or if it comes back later, it may be treated with different chemo drugs, immunotherapy, targeted drugs, or some combination of these. If the lymphoma responds to this treatment, a stem cell transplant may be an option.

Is remission a stage of treatment?

Understanding the Difference Between Cure and Remission

Cure means that there are no traces of your cancer after treatment and the cancer will never come back. Remission means that the signs and symptoms of your cancer are reduced. Remission can be partial or complete.

What are the chances of large B cell lymphoma coming back?

Around 1 in 20 people have DLBCL that comes back (relapses) in their central nervous system (CNS your brain and spinal cord) after going into remission. If this happens, the lymphoma can be very difficult to treat.

Can follicular lymphoma go into remission without treatment?

Eight were confirmed to have follicular lymphoma of whom six did not receive treatment at presentation. Four of these patients remain in remission after 14 to 30 years of follow-up and the other two have relapsed after 10 and 13 years of follow-up, respectively.

What foods should you avoid if you have lymphoma?

Avoid foods that are high in saturated fats from animal products such as meats, butters, and cheeses. Also limit trans fats that are found in processed food cooked in hydrogenated fats. These types of foods include crackers, potato chips, baked goods, and deep-fried fast foods.

Can you live 20 years with lymphoma?

Most people with indolent non-Hodgkin lymphoma will live 20 years after diagnosis. Faster-growing cancers (aggressive lymphomas) have a worse prognosis. They fall into the overall five-year survival rate of 60%.

Can I live 30 years with follicular lymphoma?

Follicular lymphoma is usually incurable but responds well to treatment. A person can live with follicular lymphoma for many years, even decades, after diagnosis.

Can you survive stage 4 diffuse large B-cell?

Diffuse large b cell lymphoma stage 4 survival rate for 5 years by stage according to SEER: Localized: 73% Regional: 73% Distant: 57%

Is R-CHOP successful?

Despite its aggressive disease course, ?50% to 70% of patients may be cured by current standard of care consisting of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy. Nevertheless, R-CHOP is found to be inadequate in 30% to 40% of patients.

How fast does DLBCL grow?

It can take 8 to 14 days after the transplant for your bone marrow to start producing new blood cells. You may need to stay in the hospital for a few weeks.

Is follicular lymphoma serious?

Follicular lymphoma is usually not considered to be curable, but more of a chronic disease. Patients can live for many years with this form of lymphoma.

Can follicular lymphoma turn into leukemia?

Follicular lymphoma transforming into acute lymphoblastic leukemia has been documented in a limited number of cases [2,3,11,12].

Can follicular lymphoma spread to the brain?

More significantly, follicular lymphomas are one of the least frequent types of indolent lymphomas to develop clinically apparent, secondary CNS spread. The presentation of an indolent follicular lymphoma with transformation to an aggressive diffuse large B-cell lymphoma within the brain parenchyma is rare.

How long does remission last in follicular lymphoma?

People with follicular lymphoma who are in remission for at least two years following treatment may no longer show detectable signs of the disease or possibly be cured.

Can Rituxan cure follicular lymphoma?

Your follicular lymphoma journey begins with initial treatment. As initial treatmentRITUXAN, with CVP chemotherapy, may be given to treat follicular lymphoma. These drugs work together in different ways to fight cancer. The goal in using this combination of drugs is to keep your cancer from getting worse.

Does follicular lymphoma relapse?

Follicular lymphoma may come back after being in remission — a period when you have few or no signs of cancer. If your cancer returns, it’s called a “relapse.” Sometimes you get a relapse after many years in remission. Whenever it happens, you still have treatment options.

How do you treat relapsed Hodgkin’s lymphoma?

Relapsed or refractory Hodgkin lymphoma is a challenging problem for clinicians who treat hematologic malignancies. The standard management of these patients should include the use of salvage chemotherapy followed by autologous stem cell transplant (ASCT) in patients who are chemotherapy sensitive.

What is relapsed refractory?

Relapsed CLL is the term for disease that responded to therapy but, after 6 or more months, stopped responding. Refractory disease is the term for CLL that does not result in a remission (but may be stable) or disease that gets worse within 6 months of the last treatment.

What is refractory treatment?

Listen to pronunciation. (reh-FRAK-tor-ee) In medicine, describes a disease or condition that does not respond to treatment.

What is relapsed/refractory ALL?

Relapsed, or recurrent, acute lymphocytic leukemia (ALL) means the leukemia has come back after treatment and reaching remission. Treatment for relapsed ALL is usually given for 23 years. Refractory disease means the leukemia did not respond to treatment.

Can relapsed DLBCL be cured?

In general, they are potentially curable with treatment and potentially curable at relapse. With aggressive lymphomas like DLBCL, somewhere between 60% and 70% of patients are cured with their initial chemoimmunotherapy treatment, said Dr. Maddocks.

How is DLBCL 2022 treated?

The standard treatment of DLBCL in 2022 remains chemo-immunotherapy with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone). Though this modality is safe and effective, up to 45%50% of patients will relapse.

What currently available products and/or regimens are you aware of for the treatment of relapsed/refractory DLBCL?

As a widely recognized standard regimen, R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone) is able to cure two-thirds patients with diffuse large B cell lymphoma (DLBCL), and the remaining patients suffer from refractory or relapsed disease due to resistance to R-CHOP and fare poorly.

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Tommy E. Junkins

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