Nathan Fowler, MD
Over the past 25 years, new regimens for follicular lymphoma have led to better overall survival; however, outcomes often dramatically vary among patients receiving the same standard treatment, such as R-CHOP.
, Fowler, an associate professor of Lymphoma/Myeloma at The University of Texas MD Anderson Cancer Center, discussed the current management of high-risk follicular lymphoma and ongoing developments in the field.
OncLive: Can you discuss the current management of high-risk follicular lymphoma?
We've known for quite some time that patients with follicular lymphoma behave differently when treated with the same therapy. Patients can get a standard therapy, such as R-CHOP and have dramatically different outcomes. In fact, some patients with the same therapy could have a median survival of around 3 to 5 years, whereas others have a median survival of 14 years.
Finally, we should not ignore methods of autologous stem cell transplant. It's been clear that if you take a patient who is refractory to one line of chemotherapy, this does not necessarily predict long-term poor outcomes. In fact, retrospective data, looking at patients who underwent a transplant, suggested that even patients who had short remissions could experience prolonged survival. Around 60% of patients following autologous transplant will have a long-term remission.
When a patient is initially diagnosed, what are some of the factors that could predict whether they will have a worse outcome?
In patients who are initially diagnosed, we know that certain clinical factors do predict patients who have a worse outcome. The FLIPI scoring system can at least accurately predict the outcome of those groups of patients. The scoring system is based on hemoglobin, stage 3 or 4 disease, a number of nodal sites, the patient's age, and their LDH.
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