Sonali M. Smith, MD, discusses how to handle patients with follicular lymphoma when they relapse, especially if they are early progressors.<br />
Sonali M. Smith, MD, Elwood V. Jensen Professor in Medicine and director of the Lymphoma Program at the University of Chicago Medicine, discusses how to handle patients with follicular lymphoma (FL) when they relapse, especially if they are early progressors.
There are multiple options at the time of relapse for these patients, but Smith believes that the data in this area lacks understanding of how to sequence treatment. She says that she will usually pull aside patients with early progression, which are patients who progress within 24 months of their frontline chemoimmunotherapy because they have poor survival outcomes. Their 5-year overall survival (OS) is about 50%. She believes this patient population need extra attention. There are several clinical trials in this setting, some physicians will offer an autologous stem cell transplant, but she thinks these early progressors need better options.
For other patients with FL, there are options such as going back to chemoimmunotherapy, rituximab (Rituxan) alone, or the recently FDA-approved combination of rituximab and lenalidomide (Revlimid), based on data from the AUGMENT trial (NCT01996865). This was a phase III randomized trial for patients with relapsed/refractory FL, who were randomized to 1 year of rituximab and lenalidomide versus 1 year of rituximab monotherapy. Smith says it is interesting that there was an improvement in not only the complete response rate but also the OS, which is what led to its approval.