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G. Cartron and J. Trotman
cine hesitancy and viral evolution globally continue to challenge confidence in achieving a safe community for our patients.
Conclusions
FL is an indolent B-cell lymphoma and affected patients now have a very prolonged median OS approaching 20 years. A hallmark of FL is its heterogeneity both at presen- tation and in the event of relapse. A significant proportion of patients managed with a “watch and wait” approach do not require any therapy, and the use of rituximab monotherapy for treating these patients is likely lower in the current COVID pandemic. With more accurate staging and expansion of therapeutic options in the modern era the treatment of each patient needs to be individualized. Nuanced decisions made in partnership with the patient and their families must account for competing priorities between efficacy and safety as we “play the long game” in lymphoma management. This is particularly important as data make it clear that neither PFS nor POD2475 are surro- gates for OS. The small but cumulative risk of histological transformation mandates biopsy at relapse, especially in patients with early symptomatic progression for whom
aggressive approaches may mitigate the poorer prognosis of early histological transformation. Conversely, for other patients a prolonged first remission after either radiothera- py for low-volume, localized disease or chemo- immunotherapy for high-tumor burden may be sustained for several years. In the elderly or those with substantial co-morbidities, FL may not relapse in their lifetime. The lack of an obvious preferred option for first-line chemo- immunotherapy for FL is exacerbated by the challenges and uncertainties of the COVID era. This pandemic brings into sharp focus the importance of attention to not just PFS but also to treatment toxicities and quality of life when choosing initial chemo-immunotherapy and making an individualized risk:benefit analysis of continuing therapy with antibody maintenance.
Disclosures
GC reports advisory fees from Roche and Celgene as well as speaker’s fees and honoraria from Takeda, Roche, Janssen, Celgene, Abbvie, Sanofi, and Gilead. JT reports research fund- ing to her institution from Beigene, Celgene-BMS, Roche, Pharmacyclics, Janssen and Takeda.
Contributions
The two authors jointly decided the plan and write the paper.
References
1.Ardeshna KM, Qian W, Smith P, et al. Rituximab versus a watch-and-wait approach in patients with advanced-stage, asymptomatic, non-bulky follicular lym- phoma: an open-label randomised phase 3 trial. Lancet Oncol. 2014;15(4):424-435.
2. Bachy E, Seymour JF, Feugier P, et al. Sustained progression-free survival benefit of rituximab maintenance in patients with follicular lymphoma: long-term results of the PRIMA study. J Clin Oncol. 2019;37(31): 2815-2824.
3. Sarkozy C, Maurer MJ, Link BK, et al. Cause of death in follicular lymphoma in the first decade of the rituximab era: a pooled analy- sis of French and US cohorts. J Clin Oncol. 2019 ; 37(2):144-152.
4. National Cancer Institute Surveillance, Epidemiology, and End Results Program. Cancer stat facts: NHL-follicular lymphoma. Accessed June 11, 2020. https://seer. cancer.gov/statfacts/html/follicular.html
5. Defossez G, Le Guyader-Peyrou S, Uhry Z, et al. Estimations nationales de l'incidence et de la mortalité par cancer en France métro- politaine entre 1990 et 2018 - Volume 1 : Tumeurs solides : Étude à partir des registres des cancers du réseau Francim. https://www.santepubliquefrance.fr/mal- adies-et-traumatismes/cancers/cancer-du- sein/documents/rapport-synthese/estima- tions-nationales-de-l-incidence-et-de-la- mortalite-par-cancer-en-france-metropoli- taine-entre-1990-et-2018-volume-1- tumeurs-solides-etud
6. Linet MS, Vajdic CM, Morton LM, et al. Medical history, lifestyle, family history, and occupational risk factors for follicular lym- phoma: the InterLymph Non-Hodgkin Lymphoma Subtypes Project. J Natl Cancer Inst Monographs. 2014;2014(48):26-40.
7. Schollkopf C, Smedby KE, Hjalgrim H, et al. Cigarette smoking and risk of non-
Hodgkin’s lymphoma-a population-based case-control study. Cancer Epidemiol Biomarkers Prev. 2005;14(7):1791-1796.
8. Chiu BC, Dave BJ, Blair A, et al. Agricultural pesticide use and risk of t(14;18)-defined subtypes of non-Hodgkin lymphoma. Blood. 2006;108(4):1363-1369.
9. AgopianJ, NavarroJM, GacAC, et al. Agricultural pesticide exposure and the molecular connection to lymphomagenesis. J Exp Med. 2009;206(7):1473-1483.
10.Sarkozy C, Baseggio L, Feugier P, et al. Peripheral blood involvement in patients with follicular lymphoma: a rare disease manifestation associated with poor progno- sis. Br J Haematol. 2014 ;164(5):659-667. Mir F, Barrington SF, Brown H, et al. Baseline SUVmax did not predict histological trans- formation in follicular lymphoma in the phase 3 GALLIUM study. Blood. 2020;135 (15):1214-1218.
PET/CT assessment in follicular lymphoma using standardized criteria: central review in the PRIMA study. Eur J Nucl Med Mol Imaging. 2014;41(3):408-415.
17. Luminari S, Biasoli I, Arcaini L, et al. The use of FDG-PET in the initial staging of 142 patients with follicular lymphoma: a retro- spective study from the FOLL05 random- ized trial of the Fondazione Italiana Linfomi. Ann Oncol. 2013;24(8):2108-2112.
18. Meignan M, Cottereau AS, Versari A, et al. Baseline metabolic tumor volume predicts outcome in high-tumor-burden follicular lymphoma: a pooled analysis of three multi- center studies. J Clin Oncol. 2016;34(30): 3618-3626,.
19. Jemaa S, Fredrickson J, Coimbra A, et al. A fully automated measurement of total meta- bolic tumor burden in diffuse large B-cell lymphoma and follicular lymphoma. Blood. 2019;134(Suppl_1):4666
20. Bachy E, Maurer MJ, Habermann TM, et al. A simplified scoring system in de novo fol- licular lymphoma treated initially with immunochemotherapy. Blood. 2018;132 (1):49-58.
21. Rutherford SC, Herold M, Hiddemann W, et al. Impact of bone marrow biopsy on response assessment in immunochemothera- py-treated lymphoma patients in GALLIUM and GOYA. Blood Adv. 2021;4(8):1589-1593.
22. Dupuis J, Berriolo-Riedinger A, Julian A, et al. Impact of [(18)F]fluorodeoxyglucose positron emission tomography response evaluation in patients with high-tumor bur- den follicular lymphoma treated with immunochemotherapy: a prospective study from the Groupe d'Etudes des Lymphomes de l'Adulte and GOELAMS. J Clin Oncol. 2012;30(35):4317-4322.
23. Trotman J, Luminari S, Boussetta S, et al. Prognostic value of PET-CT after first-line therapy in patients with follicular lym- phoma: a pooled analysis of central scan review in three multicentre studies. Lancet
11.
12.
13.
Barrington S, Trotman J, Sahin D, et al. Baseline PET-derived metabolic tumor vol- ume metrics did not predict outcomes in fol- licular lymphoma patients treated with first- line immunochemotherapy and antibody maintenance in the phase III GALLIUM study. Blood. 2018;132(Suppl 1):2882.
Nath K, Law SC, Sabdia B, et al. Intratumoral T cells have a differential impact on FDG-PET parameters in follicular lymphoma. Blood Adv. 2021;5(12):2644- 2649.
14. Swerdlow SH, Campo E, Pileri SA, et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood. 2016;127(20):2375-2390. Trotman J, Fournier M, Lamy T, et al. Positron emission tomography-computed tomography (PET-CT) after induction thera- py is highly predictive of patient outcome in follicular lymphoma: analysis of PET-CT in a subset of PRIMA trial participants. J Clin Oncol. 2011;29(23):3194-3200.
15.
16.
Tychyj-Pinel C, Ricard F, Fulham M, et al.
16
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