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Vol. 42. Issue S1.
Pages 15 (October 2020)
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Vol. 42. Issue S1.
Pages 15 (October 2020)
SP 29
Open Access
How can we estimate early relapsed follicular lymphoma and how can we treat?
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Ozan Salim
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FL is the most common indolent non-Hodgkin lymphoma, generally with favorable outcomes (median overall survival [OS] >20 years). The median age at diagnosis is 65 years. Treatment options, both in the front line and in the relapse setting, are observation, immunotherapy and chemo-immunotherapy. The addition of rituximab to standard chemotherapy has significantly improved the OS. However, current treatment options for FL is not curative and a subgroup of the patients has a more aggressive clinical course (early progression, histologic transformation). Histological transformation of FL occurs at a risk of 2% per year. At the time of diagnosis, the FL international prognostic index (FLIPI) and tumor grade are used to distinguish low-risk from high-risk patients. Median progression free survival (PFS) by the FLIPI risk group was 84, 70, and 42 months for low, intermediate, and poor risk disease, respectively. POD24-PI and m7-FLIPI scores are also investigated to predict progression free survival (PFS) in a large cohort of patients receiving first-line chemo-immunotherapy. At the time of relapse, the best available predictor of poor survival is the duration of remission following initial treatment. Relapse of FL within 24 months of chemo-immunotherapy (POD24) occurs in approximately 20% of patients. POD24 was significantly associated with inferior OS at 5 years (50% vs. 90%). The FLIPI, m7-FLIPI, and POD24-PI have been evaluated to identify POD24 patients. Sensitivity and specificity of these prognostic indices in POD24 are 70–78% and 56–58% for high risk FLIPI, 43–61% and 79–86% for high risk m7-FLIPI, 61–78% and 67–73% for high risk POD24-PI, respectively. Furthermore, gene expression profiling and circulating tumor/cell-free DNA are other emerging methods for predicting POD24. However, there is no standardized method to prospectively predict POD24. Patients with relapse FL should undergo an excisional biopsy before initiating next therapy to confirm relapse and exclude histologic transformation. Because no treatment modality has been shown to be superior to another in this situation, POD24 patients should be encouraged to participate in clinical trials whenever possible. If a patient is not a candidate for a clinical trial, treatment options include chemo-immunotherapy (such as bendamustine plus obinutuzumab(O) or O-CHOP) and targeted therapies (such as immunomodulators and PI3K inhibitors). For fit patients age <65 years without an appropriate clinical trial option consolidative autologous stem cell transplant should be considered to induce prolonged remissions and improve prognosis. Nevertheless, there is an unmet need for better identification and treatment of POD 24 patients.

Idiomas
Hematology, Transfusion and Cell Therapy
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