Roschewski Mark, Hill Brian T
1 National Cancer Institute, Bethesda, MD.
2 Cleveland Clinic, Cleveland, OH.
Am Soc Clin Oncol Educ Book. 2019 Jan;39:467-476. doi: 10.1200/EDBK_239065. Epub 2019 May 17.
Follicular lymphoma (FL) is the second most common non-Hodgkin lymphoma and the most common indolent B-cell malignancy. The disease often presents in advanced stage and can often be observed before initiation of therapy. Although the incidence is only approximately 15,000 new cases per year, the prevalence is substantially higher owing to the favorable overall survival (OS) of most patients. The most impactful advance responsible for the improvement of OS in FL was the introduction of the anti-CD20 monoclonal antibody (mAb) rituximab over 20 years ago. Phase III trials demonstrate that rituximab improves the OS in FL when combined with chemotherapy. However, unlike aggressive B-cell lymphomas, advanced stage FL is generally incurable and often displays a pattern of progressively shorter remissions with subsequent lines of therapy. Hence, maintenance strategies have been developed to prolong remissions achieved with frontline therapy. The value of maintenance after frontline therapy has been most extensively studied with extended treatment of anti-CD20 mAb, but recent approaches include chemotherapy-free combinations and targeted therapies given for extended durations. Here, we review relevant data that provide rationale in support of maintenance therapy in FL as well as the risks and limitations of a "one-size-fits-all" approach. Importantly, we note the biologic and clinical heterogeneity across patients with FL that must be considered when making clinical decisions. Finally, we highlight ongoing research that explores response-adapted approaches based on the depth of response as defined by PET scans and assays for minimal residual disease (MRD) that aim to better personalize individual management strategies.
滤泡性淋巴瘤（FL）是第二常见的非霍奇金淋巴瘤，也是最常见的惰性B细胞恶性肿瘤。该疾病常呈晚期表现，在治疗开始前往往就能观察到。尽管每年新发病例仅约15000例，但由于大多数患者总体生存期（OS）良好，其患病率要高得多。20多年前引入抗CD20单克隆抗体（mAb）利妥昔单抗是FL患者OS改善的最重大进展。III期试验表明，利妥昔单抗与化疗联合使用可改善FL患者的OS。然而，与侵袭性B细胞淋巴瘤不同，晚期FL通常无法治愈，且后续治疗的缓解期往往会逐渐缩短。因此，已制定维持治疗策略以延长一线治疗所达到的缓解期。一线治疗后的维持治疗价值在抗CD20 mAb的延长治疗中得到了最广泛的研究，但最近的方法包括无化疗联合方案和延长给药时间的靶向治疗。在此，我们回顾相关数据，这些数据为FL维持治疗提供了理论依据，以及“一刀切”方法的风险和局限性。重要的是，我们注意到FL患者存在生物学和临床异质性，在做出临床决策时必须予以考虑。最后，我们强调正在进行的研究，这些研究探索基于PET扫描定义的缓解深度和微小残留病（MRD）检测的反应适应性方法，旨在更好地实现个体化管理策略。
