How to Treat High Risk Lymphoma [video]

Since people seemed to like the last video I posted, I'm going to post another.

This one is from Lymphoma Hub, a site aimed at doctors. Members of its steering committee got together for an online discussion called "How to Treat High-Risk Follicular Lymphoma."

The discussion is hosted by Dr. Giles Salles from Sloan-Kettering in New York. Dr. Salles says this discussion is a "global perpsective." Indeed Dr. Salles moved to New York from Lyon University in France just a few years ago, and the other guests represent other hospitals and research centers from around the world. I like that -- I have to remind myself that not everyone who reads this blog is from the U.S. Sometimes I talk about treatments that aren't available yet in other parts of the world. So the global perspective is nice.

One of the guests is Dr. Stefano Luminari from the University of Modena in Italy. He talks about how he defines "high risk" in a Follicular Lymphoma patient. He pays attention to diagnostic factors like FLIPI and staging to decide whether or not a patient needs to be treated immediately. He also discusses whether to give a high-risk patient R-CHOP or R-Bendamustine. There's no easy answer there -- it depends on the patient and their situation. 

Other guests include Dr. Martin Dreyling of Ludwig-Maximilians University in Munich, Germany and Dr. Grzegorz Nowakowski of the Mayo Clinic in Minnesota, who talk about some of the limitations of FLIPI scores. Better to find as much information as possible through biopsies and scans, which may reveal more information  about the level of risk (such as whether or not a patient has transformed). Liquid biopsies may be helpful in the future. They rely on their experience to come up with a plan. And they agree that coming up with a first treatment plan for FL patients is a challenge, because there are so many different factors to consider. It's hard to say for sure which patients are "high risk."

The group also talks about high-risk FL for relapsed/refractory patients (those whose last treatment stopped working, or didn't work at all). This group is a little easier to identify as "high risk" -- POD24 and transformed patients are much more clearly in this category. For some parts of the world, treatments like CAR-T and bi-specifics are not yet available, so the best options are more intensive chemotherapy. They agree that more data is necessary to determine which treatments are best, and to help get newer treatment options approved for use.

Another guest, Dr. Michael Dickinson of the Peter McCallum Cancer Centre in Australia, was asked about different strategies including Stem Cell Transplants, which Dr. Salles points out are used much less in the U.S. lately. Dr. Dickinson points out that they are still using SCT on transformed patients, but that patients don't like them, and that many experts think that other, newer options are better. But, again, in his country, some options are not available, so STC is the best option. He said his cancer center is being more aggressive about genetic testing, to help identify biomarkers that could help patients.

It's very interesting to me to hear directly from oncologists from other countries about which options are available and which are not. The U.S. has quite a few options, but there are some that are not used. PI3K Inhibitors, for example, are available in some countries, but no longer in the U.S. 

As I said, this is a good reminder for me to continue to pay attention to news from other countries and report on it when I can. 

And it's good reminder about how heterogeneous Follicular Lymphoma is. In other words, we all seem to have slightly different variations of the same disease, and our treatment paths will be different, based on our disease and on the options available to us. 

Still, even with all of that being true, I'll keep doing my best to share what I know. I hope it continues to help.

Stay well.