STEFANO(LUMINARI((MODENA)
FIRST(LINE((
(
Follicular! lymphoma! (FL)! is! the! most! frequent! among! low>grade! B! cell! lymphomas,! and! is!
characterized! by! and! indolent! behavior,! a! relapsing! remitting! course,! a! high! sensitivity! to!
therapy!and!by!a!low!but!significant!risk!of!transformation!into!an!aggressive!subtype.!FL!is!
considered!as!an!incurable!neoplasm!but!with!current!available!therapies!natural!history!can!
be! measured! in! decades.! The! choice! of! initial! therapy! in! FL! represents! a! crucial! decisional!
point! for! the! patient! and! for! the! onco>hematologist! who! is! asked! to! choose! from! a! huge!
series!of!options!ranging!from!observation,!to!local!therapy,!or!to!immunotherapy!alone!or!
in! combination! with! chemotherapy.! Current! evidence! recommends! a! different! therapeutic!
approach!according!to!disease!extent!and!to!the!presence!of!symptoms.!Radiotherapy!is!the!
favorite! option! for! localized! disease,! observation! is! suggested! for! asymptomatic! patients!
with! advanced! disease! and! immunochemotherapy! is! the! recommended! treatment! for!
symptomatic! patients.! Even! if! recommendations! are! straightforward! in! FL,! treatment!
decisions!might!be!challenging!in!some!cases!due!to!the!weakness!of!available!evidence!or!
to! the! lack! of! clearly! superior! options! among! possible! alternatives.! Moreover,! therapeutic!
decision! can! be! further! complicated! due! to! the! growing! knowledge! about! biology! of! FL!
about!prognostic!features!and!due!to!the!availability!of!novel!therapeutic!options.!By!means!
of! three! clinical! cases! of! newly! diagnosed! FL! patients! an! overview! of! available! first! line!
option!will!be!described!and!critically!discussed.!
!
Suggested(readings:(
Matasar!MJ,!Luminari!S,!Barr!PM,!Barta!SK,!Danilov!AV,!Hill!BT,!Phillips!TJ,!Jerkeman!M,!Magagnoli!M,!
Nastoupil!LJ,!Persky!DO,!Okosun!J.Follicular!Lymphoma:!Recent!and!Emerging!Therapies,!Treatment!
Strategies,! and! Remaining! Unmet! Needs.! Oncologist.! 2019! Nov;24(11):e1236>e1250.! doi:!
10.1634/theoncologist.2019>0138.!Epub!2019!Jul!25.PMID:!31346132!!
!
Jonathon!B!Cohen!!1!,!Brad!S!Kahl!Initial!Treatment!of!Early!Stage!and!Low!Tumor!Burden!Follicular!
Lymphoma.!Hematol!Oncol!Clin!North!Am.!2020!Aug;34(4):663>672.!doi:!10.1016/j.hoc.2020.02.003.!!
Epub!2020!May!5!
!
Ciara! L! Freeman! ! 1! ,! Laurie! H! Sehn.! Initial! Treatment! of! High! Tumor! Burden! Follicular! Lymphoma!
Hematol!Oncol!Clin!North!Am.!2020!Aug;34(4):673>687.!doi:!10.1016/j.hoc.2020.02.004.!!Epub!2020!
May!5.!
!
Marcus!R,!Davies!A,!Ando!K,!Klapper!W,!Opat!S,!Owen!C,!Phillips!E,!Sangha!R,!Schlag!R,!Seymour!JF,!
Townsend!W,!Trněný!M,!Wenger!M,!Fingerle>Rowson!G,!Rufibach!K,!Moore!T,!Herold!M,!Hiddemann!
W.! Obinutuzumab! for! the! First>Line! Treatment! of! Follicular! Lymphoma.! N! Engl! J! Med.! 2017! Oct!
5;377(14):1331>1344.!doi:!10.1056/NEJMoa1614598.!
!!!