1. Understanding the Challenges of Follicular Lymphoma
Diagnostic and treatment challenges
Follicular lymphoma presents unique challenges: its slow progression can delay diagnosis, and symptoms are often vague or absent. Patients often have to cope with the uncertainty of disease evolution and treatment side effects. In some clinical trials, patients shared their experiences, highlighting the importance of psychological support and personalized medical care.
2. Initial Treatment of Follicular Lymphoma
Active surveillance or treatment
For localized forms (stages I and II), radiotherapy may be considered. In the absence of symptoms, regular monitoring, called “watchful waiting,” is sometimes preferred to avoid unnecessary side effects. This approach is particularly suitable for older patients or those with comorbidities.
3. First-Line Treatment
Chemotherapy and immunotherapy
The standard first-line treatment for symptomatic or advanced forms (stages III and IV) generally combines chemotherapy with an anti-CD20 monoclonal antibody, such as rituximab (Rituxan®). This protocol is known as R-CHOP. After chemotherapy, maintenance therapy with rituximab is often administered for two years to prolong remission.
Patient benefits: This treatment can reduce lymph node size, improve symptoms such as fatigue and pain, and extend remission, thereby enhancing overall quality of life.
4. Therapeutic Options in Case of Relapse
Targeted therapies and new drugs
In the event of relapse or resistance to initial treatment, several options are available:
- Obinutuzumab (Gazyvaro®): A more potent monoclonal antibody than rituximab, used in combination with chemotherapy or as monotherapy.
- Lenalidomide (Revlimid®): An immunomodulator administered in combination with rituximab.
- Tazemetostat (Tazveric®): An EZH2 inhibitor targeting specific genetic abnormalities of follicular lymphoma.
- Bispecific antibodies: Drugs such as mosunetuzumab (Lunsumio®) and glofitamab (Entivio®) that simultaneously target T cells and tumor cells.
Patient benefits: These targeted treatments can help control the disease more precisely, reduce relapses, and provide a less toxic alternative to traditional chemotherapy, improving tolerance and quality of life.
5. CAR-T Cell Therapy
CAR-T cells: a major advance
CAR-T cell therapies, such as Kymriah® (tisagenlecleucel) and Yescarta® (axicabtagene ciloleucel), represent a significant breakthrough in the treatment of refractory or relapsed lymphomas. These personalized therapies involve genetically modifying the patient’s T cells to target tumor cells.
Patient benefits: CAR-T therapy offers the possibility of prolonged remission even in patients resistant to conventional treatments and can significantly improve overall survival. In the UK, several hundred patients have received CAR-T therapy since its introduction.
Summary Table of Therapeutic Options
| Disease Stage | Recommended Treatment | Key Drugs | Patient Benefits |
|---|---|---|---|
| Stage I/II | Radiotherapy | – | Local disease control, symptom limitation |
| Stage III/IV | R-CHOP + Rituximab | Rituximab | Lymph node reduction, prolonged remission, improved quality of life |
| Relapse/Resistance | Obinutuzumab, Lenalidomide, Tazemetostat, Bispecific antibodies | Obinutuzumab, Lenalidomide, Tazemetostat, Mosunetuzumab | Targeted disease control, fewer side effects, reduced relapse |
| Advanced relapse | CAR-T (Kymriah, Yescarta) | Kymriah, Yescarta | Potential for prolonged remission, improved overall survival |
Conclusion
The treatment of follicular lymphoma in the UK has evolved significantly, offering patients a range of therapeutic options tailored to each stage of the disease. It is essential to consult a hematologist to determine the most appropriate treatment and receive personalized care. The goal of follicular lymphoma treatment is to control the disease, improve quality of life, and prolong remission.