Fukuhara Noriko, Ishizawa Kenichi
Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, Sendai.
Department of Third Internal Medicine, Division of Hematology and Cell Therapy, Yamagata University Faculty of Medicine, Yamagata, Japan.
Jpn J Clin Oncol. 2019 Apr 1;49(4):306-310. doi: 10.1093/jjco/hyz008.
The introduction of a chimeric anti-CD20 monoclonal antibody, rituximab, for the treatment of follicular lymphoma (FL) has dramatically improved the prognosis of this disease. Despite advances in therapy, the disease remains incurable with current standard therapeutic strategies. For advanced-stage and high-tumor-burden FL patients, a combination of rituximab with chemotherapy has improved the overall survival rates, and subsequent rituximab maintenance following successful rituximab-based chemotherapy induction also prolongs progression-free survival. Conversely, for advanced-stage low-tumor-burden FL patients, watchful waiting remains the appropriate approach, whereas rituximab monotherapy has also been suggested as a good alternative. However, the optimal timing of rituximab monotherapy in low-tumor-burden FL patients has not been clarified. It is important to address this issue for chemo-free treatment strategies. Furthermore, a predictive model for advanced low-tumor-burden patients is required to appropriately identify those patients who may benefit from immediate treatment. In this review, we address the current treatment approaches and present potential future management strategies for advanced-stage, low-tumor-burden patients.
嵌合抗CD20单克隆抗体利妥昔单抗的引入用于治疗滤泡性淋巴瘤（FL），显著改善了这种疾病的预后。尽管治疗取得了进展，但按照当前的标准治疗策略，该疾病仍然无法治愈。对于晚期和高肿瘤负荷的FL患者，利妥昔单抗与化疗联合使用提高了总生存率，并且在基于利妥昔单抗的化疗诱导成功后进行后续利妥昔单抗维持治疗也延长了无进展生存期。相反，对于晚期低肿瘤负荷的FL患者，密切观察等待仍然是合适的方法，而利妥昔单抗单药治疗也被认为是一个不错的选择。然而，低肿瘤负荷FL患者中利妥昔单抗单药治疗的最佳时机尚未明确。解决这个问题对于无化疗治疗策略很重要。此外，需要一个针对晚期低肿瘤负荷患者的预测模型，以适当地识别那些可能从立即治疗中获益的患者。在这篇综述中，我们阐述了当前的治疗方法，并提出了晚期低肿瘤负荷患者未来潜在的管理策略。
