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Despite Progress in Follicular Lymphoma and MCL, Critical Questions Remain

Caroline Seymour
Published: Wednesday, Mar 20, 2019

Izidore S. Lossos, MD

Izidore S. Lossos, MD

Although there have been significant advances in follicular lymphoma and mantle cell lymphoma (MCL), several treatment questions remain unanswered, including the role of chemoradiotherapy and whether the need for transplant can be lessened, explained Izidore S. Lossos, MD.

In early-stage follicular lymphoma, retrospective data have suggested a benefit in progression-free survival (PFS) and time to treatment failure with radiation therapy. In 2018, results from the TROG 99.03 trial suggested an additive benefit with radiotherapy and chemotherapy versus radiotherapy alone in reducing the risk of relapse and progression in patients with early-stage disease (HR, 0.57; 95% CI, 0.34-0.95; P = .033).1 However, due to the relatively short follow-up and underutilization of radiotherapy in the United States, it remains unclear where the regimen will be used in practice.

Although chemotherapy may play an important role in early-stage disease, results from the phase II RELEVANCE and phase III AUGMENT trials suggest that certain patients with advanced-stage and relapsed/refractory disease may be able to avoid chemotherapy altogether and opt for the combination of lenalidomide (Revlimid) and rituximab (Rituxan; R2) instead.

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