BACKGROUND: In patients with advanced-stage III/IV follicular lymphoma (FL), there are many treatment options available. The current challenge is to choose the optimal strategy for the individual patient. METHODS: The literature was reviewed with respect to treatment strategies in patients with advanced FL by screening the PubMed databank. RESULTS: In advanced-stage III/IV FL, median survival may approach 8-10 years. Treatment strategies include a watch-and-wait strategy, chemoimmunotherapy, monotherapy with rituximab, and - as an experimental approach so far - radioimmunotherapy. The use of autologous hematopoietic stem cell transplantation (HSCT) for patients in first remission or chemosensitive relapse prolongs progression-free survival while the effect on overall survival remains unclear compared to standard chemotherapy. However, long-term results are flawed by high relapse rates and risk of secondary malignancies. In patients with relapsed/chemoresistant disease, allogeneic HSCT constitutes the only curative approach but is associated with high treatment-related mortality. In the palliative setting, low-dose involved-field irradiation constitutes an effective treatment option in order to control local symptoms with potential long-lasting response. CONCLUSION: In case of advanced-disease FL, asymptomatic patients can be managed expectantly. In symptomatic patients, chemoimmunotherapy is regarded as standard therapy. In symptomatic elderly patients with relevant comorbidities, rituximab +/- single-agent chemotherapy, or low-dose involved-field radiotherapy might be appropriate. For younger patients with chemoresistant/relapsed disease, allogeneic HSCT might be considered, since advances in supportive care and better patient selection have resulted in improved outcomes.
BACKGROUND: In patients with advanced-stage III/IV follicular lymphoma (FL), there are many treatment options available. The current challenge is to choose the optimal strategy for the individual patient. METHODS: The literature was reviewed with respect to treatment strategies in patients with advanced FL by screening the PubMed databank. RESULTS: In advanced-stage III/IV FL, median survival may approach 8-10 years. Treatment strategies include a watch-and-wait strategy, chemoimmunotherapy, monotherapy with rituximab, and - as an experimental approach so far - radioimmunotherapy. The use of autologous hematopoietic stem cell transplantation (HSCT) for patients in first remission or chemosensitive relapse prolongs progression-free survival while the effect on overall survival remains unclear compared to standard chemotherapy. However, long-term results are flawed by high relapse rates and risk of secondary malignancies. In patients with relapsed/chemoresistant disease, allogeneic HSCT constitutes the only curative approach but is associated with high treatment-related mortality. In the palliative setting, low-dose involved-field irradiation constitutes an effective treatment option in order to control local symptoms with potential long-lasting response. CONCLUSION: In case of advanced-disease FL, asymptomatic patients can be managed expectantly. In symptomatic patients, chemoimmunotherapy is regarded as standard therapy. In symptomatic elderly patients with relevant comorbidities, rituximab +/- single-agent chemotherapy, or low-dose involved-field radiotherapy might be appropriate. For younger patients with chemoresistant/relapsed disease, allogeneic HSCT might be considered, since advances in supportive care and better patient selection have resulted in improved outcomes.
Authors: Oliver W Press; Joseph M Unger; Rita M Braziel; David G Maloney; Thomas P Miller; Michael Leblanc; Richard I Fisher Journal: J Clin Oncol Date: 2006-08-08 Impact factor: 44.544
Authors: Christina Nickenig; Martin Dreyling; Eva Hoster; Michael Pfreundschuh; Lorenz Trumper; Marcel Reiser; Hannes Wandt; Eva Lengfelder; Michael Unterhalt; Wolfgang Hiddemann Journal: Cancer Date: 2006-09-01 Impact factor: 6.860
Authors: T L Kiss; T Panzarella; H A Messner; J Meharchand; V Reddy; A D Schimmer; J H Lipton Journal: Bone Marrow Transplant Date: 2003-01 Impact factor: 5.483
Authors: E Kusumi; M Kami; Y Kanda; N Murashige; Y Kishi; R Suzuki; K Takeuchi; T E Tanimoto; T Mori; K Muta; T Tamaki; Y Tanaka; H Ogawa; T Yamane; S Taniguchi; Y Takaue Journal: Bone Marrow Transplant Date: 2005-08 Impact factor: 5.483
Authors: Thomas E Witzig; Christine A White; Leo I Gordon; Gregory A Wiseman; Christos Emmanouilides; James L Murray; John Lister; Pratik S Multani Journal: J Clin Oncol Date: 2003-04-01 Impact factor: 44.544
Authors: Robert Marcus; Kevin Imrie; Andrew Belch; David Cunningham; Eduardo Flores; John Catalano; Philippe Solal-Celigny; Fritz Offner; Jan Walewski; Joäo Raposo; Andrew Jack; Paul Smith Journal: Blood Date: 2004-10-19 Impact factor: 22.113
Authors: Alfred Haidenberger; Sabine Fromm-Haidenberger; Alexander de Vries; Bela-Andre Popper; Michael Steurer; Ira Skvortsova; Johanna Kantner; Eberhard Gunsilius; Peter Lukas Journal: Strahlenther Onkol Date: 2011-04-26 Impact factor: 3.621