Expert Perspectives on a 75-Year-Old Woman With Relapsed/Refractory Follicular Lymphoma - Episode 4
A key opinion leader in the treatment of FL provides insight on the decision of whether to add maintenance therapy to the treatment regimen.
Loretta Nastoupil, MD: After patients complete their frontline or subsequent lines of therapy, they transition into active surveillance. There’s no good evidence as to the preferred strategy for active surveillance. Clinicians will often rely on guidelines from the NCCN [National Comprehensive Cancer Network] or their own SOPs [standard operating procedures] to derive how to pursue active surveillance. It is not unreasonable to assess patients every 3 to 6 months for a number of years and then transition to no more frequently than once a year. Whether to pursue active surveillance, meaning imaging studies or imaging modalities such as CT or PET [positron emission tomography], is not clearly defined. It is our common practice to pursue CT surveillance in the absence of concern for clinical transformation every 6 to 12 months. Once they get beyond 5 years, surveillance should be no more frequently than every 12 months.
There are other practices where they may not pursue any imaging modality in the absence of clinical concern for progressive disease. My only concern about that strategy is that at least half of patients will not have B symptoms. They may not have laboratory abnormalities, so you may be missing patients who are in need of therapy as a result of bulky or significant adenopathy that will only be picked up on an imaging study. I don’t advocate for CT scans every 6 months for patients who are looking at a natural life expectancy of about 18 to 20 years, but particularly in the first 5 years, routine surveillance imaging can be of benefit, mostly to identify patients with an early progression event.
Once patients get beyond that 24-month mark and are no longer concerned about being a patient with POD24 [progression of disease within 24 months], active surveillance can be performed based off of patient symptom burden, lab abnormalities that may be followed, and comfort level in terms of intervals. I frequently see patients every 12 months. In addition to being monitored for signs of recurrent follicular lymphoma, it’s also important to note that these patients are at higher risk for second cancers, so we’re also pursuing active survivorship, meaning ensuring they are up to date in terms of screening for other cancers. It’s important to ensure they’re up to date on mammograms, colonoscopies, and skin examinations. Basal cell and squamous cell carcinomas also occur more frequently in this patient population.
This transcript has been edited for clarity.
Case: A 75-Year-Old Woman With Relapsed/Refractory Follicular Lymphoma