Trotman Judith, Falconer Janlyn
Concord Repatriation General Hospital, University of Sydney, Concord, NSW, Australia.
Hematology Am Soc Hematol Educ Program. 2024 Dec 6;2024(1):293-300. doi: 10.1182/hematology.2024000654.
We are now a quarter of a century after the transformative impact of rituximab in improving overall survival for patients with follicular lymphoma. With a burgeoning array of effective immunochemotherapy approaches, we can now frame many patients' expectations of longevity and a "functional cure," with survival estimates for many newly diagnosed patients comparable to age- and gender-matched populations. We highlight not just heterogeneity in disease but also in patients, which influences therapeutic decision-making in an immunochemotherapy era where progression-free survival advances are associated with efficacy-toxicity trade-offs, and no clear overall survival advantage is associated with any specific regimen. We provide the metrics that assist, prognostication both at diagnosis and after initial therapy, but we also highlight the limited long-term follow-up in institutional, population, and clinical trial data sets to inform our survival estimates. Nonetheless, the data are sufficient to empower us to reframe more optimistic conversations with our patients and the lymphoma community, discussions that engender hope and planning for a life lived long, and well, after therapy for follicular lymphoma.
利妥昔单抗对改善滤泡性淋巴瘤患者的总生存期产生了变革性影响，如今已过去四分之一个世纪。随着一系列有效的免疫化疗方法不断涌现，我们现在能够勾勒出许多患者对长寿和“功能性治愈”的期望，许多新诊断患者的生存预期与年龄和性别匹配的人群相当。我们不仅强调了疾病的异质性，还强调了患者的异质性，这在免疫化疗时代会影响治疗决策。在这个时代，无进展生存期的进展与疗效-毒性权衡相关，且没有任何特定方案具有明确的总生存期优势。我们提供了有助于在诊断时和初始治疗后进行预后评估的指标，但我们也强调了机构、人群和临床试验数据集中长期随访的局限性，这会影响我们对生存期的估计。尽管如此，这些数据足以让我们与患者及淋巴瘤群体进行更乐观的交流，这些交流能带来希望，并为滤泡性淋巴瘤治疗后的长寿和美好生活做好规划。
