Info
Relapsed or Refractory Disease
Consider transformed disease at progression, pts can be screened w/ PET but confirmation should be w/ bx when possible Asx relapsed pts can be observed, as w/ untreated pts Choice of 2nd-line Rx influenced by quality & duration of response to initial Rx. Front-line regimen can be re-used if remission duration was long (> expected median duration) If rituximab-sensitive (PFS >6 months after last rituximab): Rituximab ± chemo remains effective in relapsed pts. Rituximab monotherapy ORR is ~45%, but is more commonly combined w/ chemotherapy in relapsed pts If rituximab-refractory: Obinutuzumab-Benda → Obinutuzumab maintenance improves PFS & OS c/w bendamustine monotherapy (GADOLIN Study, Lancet Oncol 2016) Idelalisib monotherapy or lenalidomide plus rituximab alternative options in relapsed/refractory FL, w/ idelalisib approved after 2 prior Rx Radioimmunotherapy Very low-dose RT (400 cGy) provides excellent local control & palliation in 70% of R/R pts Pts w/a short remission duration who fail to achieve EFS12 or PFS24 should be considered for consolidation w/ high dose therapy and autologous stem cell rescue or allogeneic stem cell transplant after the 2nd-line Rx Choice of autologous or allogeneic transplant is made individually; usually based on such factors as pt age & comorbidity, availability of a suitable donor, & the biology & behavior of the lymphoma