Update on Follicular Lymphoma

The medical journal Hematological Oncology published a great article last month called "Update on Follicular Lymphoma." I like articles like these, and I try to link to them when I can. They aren't presenting any new research; they're just trying to say "There's a lot going on with FL, so let's stop and take a look at where we are."

This particular article keeps its focus on what has happened over the last 3 years, and it highlights six particular things that should give us all hope. I won't give too much commentary on them, since I've written about all of them in the blog (I'm linking to my blog posts, which you should be able to use to find further links with more information). But it's nice to see them all in one place. You can read the article for more detail.

Here are the six things that the article highlights.

1) Bone marrow biopsies are not necessary for most patients with FL. The research actually focused on Bone Marrow Biopsies in clinical trials, but the general lesson is pretty much the same -- Bone Marrow Biopsies are awful, and they probably don't tell us anything more than other diagnostic tests tell us. There seems to be a growing movement to do away with them.

2) Validation of POD24 status. POD24 refers to the idea that patients who have Progression of Disease (POD) within 24 months of receiving immuno-chemotherapy (like B-R or R-CHOP) tend to have a lower median rate of survival. Within the last 3 years, research has confirmed that POD24 is valid. The good news is that this has created more research on this population of FL patients (it affects about 20% of us), which hopefully will help identify them earlier (right now they are only identified when the disease progresses), and those biomarkers might lead to new treatments for them.

3) Long-term follow up of the RELEVANCE trial for R-Squared. The RELEVANCE trial showed that R-Squared (a combination of Rituxan and Revlemid/Lenalidomide) was as effective as traditional chemotherapy for Relapsed and Refractory FL patients. (It also has a different set of side effects -- not better safety, but different.) This was the first treatment that showed that a non-chemotherapy treatment could be as effective as chemo. A big deal. 

4) Response-Adapted Treatment is not Superior. I'm a little surprised that this one made the list, but it's important. It describes research that compared Rituxan Maintenance with response-adapted treatment (basically, that you don't treat someone a second time until they shows signs of needing treatment). The researchers had guessed that response-adapted treatment would be better than Maintenance (fewer side effects, less cost). But they found that PET scans didn't always pick up the returning disease, so Maintenance might be a better option -- or at least as good an option. Not much follow-up on it, though, from what I can tell. Maybe that's coming soon.

5) The Bi-specific Mosunetuzumab is pretty great. I assume I don't need to get too much into this.

6) And so it CAR-T. Same here.

As I said, none of this is new research. But it's great to see all of these positive developments in one place. As the authors point out, these developments aren't the end. In almost every case, they are the beginning of additional research that could change our lives for the better, in a number of ways -- focusing research in new directions, improving our quality of life, or even (dare I say it?) moving closer to a cure.

I'm looking forward to sharing six more great advances a few years from now. I know they'll be coming.