Follicular Non-Hodgkin Lymphoma: First Relapse and Beyond
DOI:
https://doi.org/10.58931/cht.2024.3148Abstract
Follicular lymphoma (FL) is the most common indolent subtype of non-Hodgkin Lymphoma (NHL) and the second most common type of lymphoma overall. In Canada the age‑standardized incidence of FL is 38.3 cases per million individuals per year with mean age at diagnosis of 60 and similar incidence in men and women. Follicular lymphoma is treatable but not curable with systemic therapy yet it maintains a median overall survival (OS) of approximately 20 years. Historically, this long median survival has been maintained through periods of watchful waiting and subsequent treatment with chemoimmunotherapy when the disease burden becomes symptomatic. Serial relapses with progressively shorter remissions and more resistant disease is the usual natural history for FL. The management of relapsed FL remains controversial and the decision on next line of therapy is a rapidly evolving area, with the old standard repetition of chemoimmunotherapy being contested by new targeted therapies. There remains a challenge for Canadian patients to access these novel therapies outside of clinical trials and access programs. This review will present a treatment approach for relapsed FL taking into consideration Canadian funding patterns, in addition to reviewing the novel drugs with the highest level and most mature evidence to date.
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