滤泡性淋巴瘤管理的进展：综合综述

Follicular lymphoma (FL) is the most common subtype of indolent non-Hodgkin lymphoma in Western countries. While FL is generally incurable, standard initial therapies are associated with high response rates and durable remissions for most patients.

In addition, novel targeted agents and immunotherapies are changing the treatment algorithm for patients with relapsed or refractory disease. This review discusses the initial staging, prognosis, and treatment options for newly diagnosed and relapsed/refractory FL. Initial treatment options for FL include active surveillance, radiotherapy, rituximab monotherapy, and chemoimmunotherapy. Staging with positron emission tomography/computed tomography and bone marrow biopsy is crucial for identifying early-stage patients. Most patients with FL will receive chemoimmunotherapy as the initial treatment with options including rituximab or obinutuzumab plus cyclophosphamide, vincristine, and prednisone; cyclophosphamide, doxorubicin, vincristine, and prednisone; bendamustine; or lenalidomide. No significant differences in overall survival have been observed in randomized studies comparing these regimens. Maintenance therapy with rituximab or obinutuzumab in responders to initial chemoimmunotherapy improves progression-free survival. For relapsed/refractory FL, treatment options include chemoimmunotherapy, lenalidomide-based regimens, tazemetostat, chimeric antigen receptor (CAR)-T cell therapy (axicabtagene ciloleucel and tisagenlecleucel), and CD3/CD20 bispecific antibodies (BsAbs). Given the encouraging outcomes obtained with CAR-T cell therapy and BsAbs, multiple trials are testing these highly active agents in earlier lines of therapy and among high-risk patients with early relapse after frontline chemoimmunotherapy. Additional studies and follow-up are needed to understand how these novel agents may further change treatment algorithms for FL. Folik ler lenfoma (FL), Bat lkelerindeki indolent non-Hodgkin lenfoman n en yayg n alt t r d r.

FL genellikle tedavi edilemez olsa da, standart ba lang tedavileri o u hastada y ksek yan t oranlar ve s rd r lebilir remisyonlarla ili kilidir. Ayr ca, yeni hedefli ajanlar ve imm noterapiler, relaps veya refrakter hastal olan hastalar n tedavi algoritmalar n de i tirmektedir. Bu derleme, yeni tan konmu ve relaps/refrakter FL i in ba lang evrelemesi, prognoz ve tedavi se eneklerini tart maktad r. FL i in ba lang tedavi se enekleri aras nda aktif g zetim, radyoterapi, rituksimab monoterapisi ve kemoimm noterapi yer almaktad r. Pozitron emisyon tomografisi/bilgisayarl tomografi ve kemik ili i biyopsisi ile evreleme, erken evre hastalar tan lamak i in kritiktir. FL hastalar n n o u, rituksimab veya obinutuzumab ile birlikte siklofosfamid, vinkristin, prednizon, siklofosfamid, doksorubisin, vinkristin, prednizon, bendamustin veya lenalidomid gibi se enekleri i eren kemoimm noterapiyi ba lang tedavisi olarak alacakt r.

Bu rejimleri kar la t ran randomize al malarda genel sa kal mda nemli farklar g zlemlenmemi tir. Rituksimab veya obinutuzumab ile idame tedavisi, ba lang kemoimm noterapisine yan t veren hastalarda progresyonsuz sa kal m art r r. Relaps/refrakter FL i in tedavi se enekleri, kemoimm noterapi, lenalidomide tabanl rejimler, tazemetostat, kimerik antijen resept r (CAR)-T-h cre terapisi (aksikabtagen sileulesel ve tisagenlecleucel) ve CD3/CD20 bispesifik antikorlar (BsAb) i ermektedir.

CAR-T h cre tedavisi ve BsAb lerle umut verici sonu lar al nd ndan, bu y ksek etkili ajanlar n tedavi algoritmalar n FL nin n tedaviden sonraki erken relaps olan y ksek riskli hastalarda test etmek i in bir ok al ma yap lmaktad r. Bu yeni ajanlar n FL i in tedavi algoritmalar n nas l daha fazla de i tirebilece ini anlamak i in ek al malar ve takip gereklidir.