Front-line management of non-Hodgkin lymphoma in Australia. Part 1: follicular lymphoma

Judith Trotman, Chan Y. Cheah, Paula Marlton, Stephen Opat

Research output: Contribution to journalReview article

Abstract

Outcomes with follicular lymphoma (FL) have improved in the modern era and median survival is now beyond 15 years. Therapeutic decisions need to consider this increased survival as well as recent clinical trial data and emerging treatments. In this context, we present here current approaches to front-line management of FL in Australia. Treatment choices depend on the disease stage, tumour burden, the patient's age, symptoms, comorbidities and preferences. Only about 10–15% of patients with FL are diagnosed with early stage disease. For patients with low-grade, early stage disease, radiotherapy (RT) is recommended. The addition of chemotherapy has been shown to increase progression-free survival (PFS) but without demonstrated overall survival advantage. For patients with low-tumour-burden, advanced-stage FL, immediate treatment may not be required and we recommend considering active monitoring. For stage III/IV disease that is symptomatic and/or with high tumour burden, established first-line treatment is chemotherapy in combination with rituximab, often followed by rituximab maintenance. The listing of bendamustine and now obinutuzumab on the Pharmaceutical Benefits Scheme has expanded the first-line treatment options in Australia to include bendamustine in combination with rituximab (without rituximab maintenance permitted) or with obinutuzumab plus 2 years obintuzumab maintenance. In the FL subgroup of the Study group indolent Lymphomas (StiL) trial, therapy with bendamustine plus rituximab significantly increased PFS compared with rituximab in combination with cyclophosphamide, doxorubicin, vincristine and prednisolone, without rituximab maintenance. Initial tolerability may be more favourable with bendamustine in combination with anti-CD20 antibody therapy than other therapies overall, but clinical vigilance is still required because of concerns of late infectious toxicities associated with prolonged T-cell depletion.

Original languageEnglish
Pages (from-to)422-433
Number of pages12
JournalInternal Medicine Journal
Volume49
Issue number4
DOIs
Publication statusPublished - 1 Apr 2019

Fingerprint

Follicular Lymphoma
Non-Hodgkin's Lymphoma
Tumor Burden
Maintenance
Therapeutics
Disease-Free Survival
Survival
Vincristine
Prednisolone
Rituximab
Combination Drug Therapy
Doxorubicin
Cyclophosphamide
Comorbidity
Anti-Idiotypic Antibodies
Lymphoma
Radiotherapy
Clinical Trials
T-Lymphocytes
Drug Therapy

Cite this

Trotman, Judith ; Cheah, Chan Y. ; Marlton, Paula ; Opat, Stephen. / Front-line management of non-Hodgkin lymphoma in Australia. Part 1 : follicular lymphoma. In: Internal Medicine Journal. 2019 ; Vol. 49, No. 4. pp. 422-433.
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abstract = "Outcomes with follicular lymphoma (FL) have improved in the modern era and median survival is now beyond 15 years. Therapeutic decisions need to consider this increased survival as well as recent clinical trial data and emerging treatments. In this context, we present here current approaches to front-line management of FL in Australia. Treatment choices depend on the disease stage, tumour burden, the patient's age, symptoms, comorbidities and preferences. Only about 10–15{\%} of patients with FL are diagnosed with early stage disease. For patients with low-grade, early stage disease, radiotherapy (RT) is recommended. The addition of chemotherapy has been shown to increase progression-free survival (PFS) but without demonstrated overall survival advantage. For patients with low-tumour-burden, advanced-stage FL, immediate treatment may not be required and we recommend considering active monitoring. For stage III/IV disease that is symptomatic and/or with high tumour burden, established first-line treatment is chemotherapy in combination with rituximab, often followed by rituximab maintenance. The listing of bendamustine and now obinutuzumab on the Pharmaceutical Benefits Scheme has expanded the first-line treatment options in Australia to include bendamustine in combination with rituximab (without rituximab maintenance permitted) or with obinutuzumab plus 2 years obintuzumab maintenance. In the FL subgroup of the Study group indolent Lymphomas (StiL) trial, therapy with bendamustine plus rituximab significantly increased PFS compared with rituximab in combination with cyclophosphamide, doxorubicin, vincristine and prednisolone, without rituximab maintenance. Initial tolerability may be more favourable with bendamustine in combination with anti-CD20 antibody therapy than other therapies overall, but clinical vigilance is still required because of concerns of late infectious toxicities associated with prolonged T-cell depletion.",
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Front-line management of non-Hodgkin lymphoma in Australia. Part 1 : follicular lymphoma. / Trotman, Judith; Cheah, Chan Y.; Marlton, Paula; Opat, Stephen.

In: Internal Medicine Journal, Vol. 49, No. 4, 01.04.2019, p. 422-433.

Research output: Contribution to journalReview article

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