Le lymphome folliculaire non hodgkinien : La première rechute et au-delà
Résumé
Le lymphome folliculaire (LF) est le sous‑type de lymphome non hodgkinien (LNH) indolent le plus fréquent, et globalement, le deuxième type de lymphome le plus fréquent. Au Canada, l’incidence du LF normalisée selon l’âge est de 38,3 cas par million d’individus par an. L’âge moyen au moment du diagnostic est de 60 ans et l’incidence chez les hommes et les femmes est similaire. Le lymphome folliculaire peut être traité par une thérapie systémique, mais demeure incurable. On observe une survie globale (SG) médiane d’environ 20 ans pour le LF. Historiquement, cette longue médiane de survie a été maintenue grâce à des périodes de surveillance vigilante et de traitement par chimio-immunothérapie lorsque la maladie devient symptomatique. L’histoire naturelle habituelle du LF consiste en une succession de rechutes et de rémissions, de plus en plus courtes, et une maladie de plus en plus réfractaire. La prise en charge du LF en rechute reste controversée et la décision concernant la prochaine ligne de traitement est un domaine qui évolue rapidement. L’ancienne norme qui consistait à répéter la chimio-immunothérapie initiale est contestée par l’arrivée des nouvelles thérapies ciblées. Il demeure difficile pour les patients canadiens d’accéder à ces nouvelles thérapies en dehors des essais cliniques et des programmes d’accès. Cette revue présentera une approche thérapeutique pour le LF en rechute en tenant compte des schémas de remboursement canadiens, en plus de revoir les nouveaux médicaments qui ont le plus haut niveau de preuves et les données les plus à ce jour.
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