Follicular lymphoma: an update on biology and optimal therapy

• Published in: Leukemia & Lymphoma Vol. 64; no. 4; pp. 761 - 775
• Main Authors: Fischer, Luca, Dreyling, Martin
• Format: Journal Article
• Language: English
• Published: United States Taylor & Francis 21.03.2023; Informa UK Limited
• Subjects: Antineoplastic Combined Chemotherapy Protocols; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biology; Follicular lymphoma; Humans; immunochemotherapy; immunotherapy; Lymphoma, Follicular; Lymphoma, Follicular - diagnosis; Lymphoma, Follicular - genetics; Lymphoma, Follicular - therapy; Neoplasm Recurrence, Local; Neoplasm Recurrence, Local - drug therapy; Rituximab; Rituximab - therapeutic use; Follicular lymphoma; biology; immunochemotherapy; immunotherapy
• ISSN: 1042-8194; 1029-2403; 1029-2403
• DOI: 10.1080/10428194.2023.2174804

Follicular lymphoma (FL) is a mature B-cell neoplasm with a mostly indolent course. Genetic hallmark characteristics are Bcl-2 overexpression based on a t(14;18) translocation and additional secondary genetic and epigenetic aberrations. Standard treatment for early-stage patients has curative intent and usually consists of radiotherapy with or without rituximab. In the advanced stage, the main therapeutic focus is on prolonged remissions. Therefore, treatment in asymptomatic patients is usually deferred. Symptomatic patients are subject to immunochemotherapy induction followed by antibody maintenance. Importantly, about one in five patients subsequently experiences a more rapid clinical course, achieving only short remissions with multiple relapses (POD24). In those patients, there is still an urgent need for improved therapeutic options. Accordingly, a plethora of targeted and immunotherapeutic options, including immunomodulatory drugs, small molecule inhibitors, monoclonal antibodies as well as bispecific T-cell engager antibodies and CAR-T cell products have been recently evaluated in such relapsed high-risk patients.