Treating Patients With Indolent Lymphomas in the Relapsed Setting

Brad Kahl, MD, professor of medicine, Division of Oncology, Siteman Cancer Center, Washington University School of Medicine in St. Louis, discusses the treatment options for patients with indolent lymphomas who are relapsed/refractory.

Managing patients in this setting is complicated because there are so many factors to consider, Kahl says. To start, there are a lot of optionsavailable. Patient-specific factors should be considered, such as age, underlying health, and goals of treatment. Prior treatments should also be considered and how well they worked in the patient who relapsed.

If a patient received frontline therapy which worked beautifully and was well-tolerated, physicians can offer than the same treatment again. However, Kahl notes this does not happen often as there are so many other treatment options available.

The most common scenario may be a patient received bendamustine (Bendeka) plus rituximab (Rituxan), had a nice remission, but the disease returns, perhaps as a follicular lymphoma (FL) 4 to 6 years later. Kahl says the conversation with the patient would be moving the patient to lenalidomide (Revlimid) plus rituximab. This regimen is already approved by the FDA, based on the AUGMENT trial which demonstrated a 28-month progression-free survival in a head-to-head comparison with rituximab plus placebo. There also appeared to be a survival advantage in patients with FL compared with rituximab/placebo, Kahl says.

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