Maruyama Dai
Department of Hematology Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research.
Rinsho Ketsueki. 2024;65(9):1004-1011. doi: 10.11406/rinketsu.65.1004.
Follicular lymphoma (FL) is the most common subtype of indolent lymphoma. Survival outcomes for FL have improved since the introduction of anti-CD20 monoclonal antibodies, such as rituximab, and median overall survival has reached 15-20 years. However, FL is an incurable disease that subsequently progresses or relapses, and progression-free and overall survival tend to shorten with repeated relapses. For patients with limited-stage disease, radiation therapy is generally the treatment of choice and results in a median survival of approximately nearly 20 years. For advanced-stage patients with low tumor burden, watchful waiting continues to be the appropriate strategy at present. It remains unclear whether rituximab monotherapy might change this watchful waiting approach and result in a benefit from early intervention in patients with low tumor burden. For advanced-stage patients with high tumor burden, chemoimmunotherapy including rituximab or obinutuzumab followed by maintenance therapy is the standard treatment. For relapsed or refractory patients, treatment options such as chemoimmunotherapy, lenalidomide-rituximab, tazemetostat, chimeric antigen receptor T-cell therapies, and CD3/CD20 bispecific antibodies are available or in development. This review presents current standard treatments, recent advances, and future perspectives on the management of FL.
滤泡性淋巴瘤（FL）是惰性淋巴瘤最常见的亚型。自引入抗CD20单克隆抗体（如利妥昔单抗）以来，FL的生存结局有所改善，中位总生存期已达15至20年。然而，FL是一种无法治愈的疾病，随后会进展或复发，无进展生存期和总生存期往往会随着复发次数的增加而缩短。对于局限期疾病患者，放射治疗通常是首选治疗方法，中位生存期约为近20年。对于肿瘤负荷低的晚期患者，目前密切观察等待仍是合适的策略。利妥昔单抗单药治疗是否会改变这种密切观察等待的方法，并使肿瘤负荷低的患者从早期干预中获益，目前尚不清楚。对于肿瘤负荷高的晚期患者，包括利妥昔单抗或奥妥珠单抗的化学免疫疗法随后进行维持治疗是标准治疗方法。对于复发或难治性患者，化学免疫疗法、来那度胺-利妥昔单抗、他泽司他、嵌合抗原受体T细胞疗法和CD3/CD20双特异性抗体等治疗选择已经可用或正在研发中。本综述介绍了FL治疗的当前标准治疗方法、最新进展和未来展望。
