Department of Oncology, Hospital Costa del Sol, Marbella, Spain.
BMC Cancer. 2012 May 31;12:210. doi: 10.1186/1471-2407-12-210.
Historically, the median overall survival for follicular lymphoma (FL) has been considered to be 9-10 years, and no treatment had ever prolonged this time period. Studies conducted more than 20 years ago demonstrated that treating patients with asymptomatic FL at the onset of the disease did not increase their survival, and that almost 20% of these patients did not need any treatment in the first 10 years of follow-up. Based on these facts, most clinical practice guidelines recommend active surveillance policies for patients with asymptomatic FL.
The introduction of antiCD-20 monoclonal antibodies, over the last 15 years, has significantly increased the median survival rate to above 14 years. This improvement was achieved before the combination of rituximab and chemotherapy regimens became extensively used in patients with symptomatic disease. Therefore, this increase in survival may currently be more significant. At present, several clinical trials have evaluated low-toxicity therapies that prolong progression-free periods, among which rituximab monotherapy, radioimmunotherapy or the combination of rituximab with bendamustine are the most relevant. Unfortunately, these clinical trials have included only patients with symptomatic FL. The results of a recently reported clinical trial show that treatment with single-agent rituximab prolongs progression-free survival rates, time to new treatment and the quality of life of asymptomatic patients, as compared with the active surveillance strategy. Longer follow-up of these results and data regarding overall survival are awaited before this treatment can be recommended as the standard initial therapy.
There are different therapeutic possibilities for asymptomatic FL patients, but no data are currently available to indicate which option is the best. Patients need to understand the risks and benefits of observation versus treatment before a final decision can be made. For patients who want active treatment the administration of four weekly rituximab doses should be considered.
滤泡性淋巴瘤（FL）的中位总生存期（OS）曾被认为是 9-10 年，并且没有任何治疗方法能延长这一时期。20 多年前进行的研究表明，在疾病发作时对无症状 FL 患者进行治疗并不能提高其生存率，而且在随访的前 10 年中，近 20%的患者无需任何治疗。基于这些事实，大多数临床实践指南建议对无症状 FL 患者采取积极监测策略。
过去 15 年来，抗 CD-20 单克隆抗体的引入显著提高了中位 OS 率，超过 14 年。这种改善是在利妥昔单抗与化疗方案联合广泛应用于有症状疾病患者之前实现的。因此，目前这种生存率的提高可能更为显著。目前，有几项临床试验评估了能够延长无进展期的低毒性疗法，其中包括利妥昔单抗单药治疗、放射免疫疗法或利妥昔单抗联合苯达莫司汀。遗憾的是，这些临床试验仅纳入了有症状 FL 患者。最近报告的一项临床试验结果显示，与主动监测策略相比，单药利妥昔单抗治疗可延长无症状患者的无进展生存期、开始新治疗的时间和生活质量。在推荐该治疗方法作为初始治疗标准之前，还需要对这些结果进行更长时间的随访，并获得关于总生存期的数据。
无症状 FL 患者有不同的治疗选择，但目前尚无数据表明哪种选择最佳。在做出最终决定之前，患者需要了解观察与治疗的风险和获益。对于希望积极治疗的患者，应考虑给予每周 4 次利妥昔单抗治疗。
