Kameoka Yoshihiro
Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine.
Rinsho Ketsueki. 2022;63(9):1135-1144. doi: 10.11406/rinketsu.63.1135.
Follicular lymphoma (FL) is the most common type of low-grade, non-Hodgkin lymphoma. Although FL is generally a chemo-sensitive disease, current treatment strategies cannot cure patients with advanced-stage FL. Therefore, FL patients experience remission and relapse many times and generally have a long clinical course. The treatment goals for FL focus on improving subjective symptoms, recovery of cytopenia, and improvement in the quality of life. Careful watch and wait is an important treatment for asymptomatic FL with a low tumor burden. Rituximab monotherapy is also an important option for patients who have mild symptoms. The standard treatment for FL with a high tumor burden includes a combination of anti-CD20 antibodies, like rituximab or obinutuzumab, and chemotherapy like bendamustine and CHOP. The group with poor prognosis FL, such as POD24, should be considered for high-intensity therapies that include hematopoietic cell transplantation. In recent years, the development of molecular targeted therapies for recurrent FL has been vigorously promoted. Recently, lenalidomide and tazemetostat have been approved in Japan. This manuscript outlines the treatment strategy for untreated and relapsed FL and discusses future issues.
滤泡性淋巴瘤（FL）是最常见的低度非霍奇金淋巴瘤类型。尽管FL通常是一种对化疗敏感的疾病，但目前的治疗策略无法治愈晚期FL患者。因此，FL患者会多次缓解和复发，临床病程通常较长。FL的治疗目标侧重于改善主观症状、血细胞减少的恢复以及生活质量的提高。密切观察等待是对肿瘤负荷低的无症状FL的重要治疗方法。利妥昔单抗单药治疗也是症状较轻患者的重要选择。对肿瘤负荷高的FL的标准治疗包括抗CD20抗体（如利妥昔单抗或奥妥珠单抗）与化疗药物（如苯达莫司汀和CHOP）联合使用。预后较差的FL组，如POD24，应考虑采用包括造血细胞移植在内的高强度治疗。近年来，复发性FL的分子靶向治疗得到了大力推进。最近，来那度胺和他泽司他已在日本获批。本文概述了初治和复发FL的治疗策略，并讨论了未来的问题。
