[en] After diffuse large B-cell lymphoma, follicular lymphoma is the most frequent non-Hodgkin's lymphoma. It remains incurable, except for localized diseases. Advanced disease has to be treated only in the presence of clinical and/or biology aggressiveness. These patients should be treated by rituximab (Mab-Thera) associated to polychemotherapy comprising cyclophosphamide, vincristine and prednisone. After this therapy, the benefit of rituximab in maintenance has to be confirmed. Autologous stem cell transplantation is also an interesting option. The other therapeutic options comprise radio-immunotherapy with 90Y ibritumomab tiuxetan (Zevalin) and bortezomib (Velcade). [fr] Lymphome le plus fréquent après le lymphome B diffus à grandes cellules, le lymphome folliculaire de stade avancé reste incurable. Les formes avancées ne doivent être traitées qu'en présence de signes cliniques et/ou biologiques signant l'agressivité de la maladie. Le traitement de première ligne associe le rituximab (MabThera) à la polychimiothérapie à base de cyclophosphamide, vincristine et prednisone. Après ce traitement, le bénéfice du rituximab en maintenance doit être validé. L'autogreffe de moelle est réservée au traitement des rechutes des patients jeunes. L'allogreffe de moelle est une option intéressante pour les patients éligibles. Les autres options thérapeutiques disponibles en cas de rechute comprennent l'immuno-radiothérapie par 90Y-ibritumomab tiuxétan (Zevalin) et, plus récemment, le bortézomib (Velcade).
Disciplines :
Hematology
Author, co-author :
Bonnet, Christophe ; Université de Liège - ULiège > Département des sciences cliniques > Hématologie - Oncologie médicale
Beguin, Yves ; Université de Liège - ULiège > Département des sciences cliniques > Hématologie - Oncologie médicale
de Leval, Laurence ; Université de Liège - ULiège > Département des sciences biomédicales et précliniques > Anatomie et cytologie pathologiques - Département des sciences biomédicales et précliniques
Fillet, Georges ; Université de Liège - ULiège > Département des sciences cliniques > Hématologie - Oncologie médicale
* Cheson BD, Pfistner B, Juweid ME, et al. Revised response criteria for malignant lymphoma. J Clin Oncol 2007;25:579-586
** Solal-Celigny P, Roy P, Colombat P, et al. Follicular lymphoma international prognostic index. Blood 2004;104:1258-1265
* Salles G, Mounier N, de Guibert S, et al. Rituximab combined with chemotherapy and interferon in follicular lymphoma patients: Results of the GELA-GOELAMS FL2000 study. Blood 2008;112:4824-4831
Haas RL, Poortmans P, de Jong D, et al. High response rates and lasting remissions after low-dose involved field radiotherapy in indolent lymphomas. J Clin Oncol 2003;21:2474-2480 (Pubitemid 46606327)
Advani R, Rosenberg SA, Horning SJ. Stage I and II follicular non-Hodgkin's lymphoma: Long-term follow-up of no initial therapy. J Clin Oncol 2004;22:1454-1459 (Pubitemid 41103628)
Brice P, Bastion Y, Lepage E, et al. Comparison in low-tumor-burden follicular lymphomas between an initial no-treatment policy, prednimustine, or interferon alfa: A randomized study from the Groupe d'étude des lymphomes folliculaires. Groupe d'étude des lymphomes de l'adulte. J Clin Oncol 1997;15:1110-1117
** Cheson BD, Leonard JP. Monoclonal antibody therapy for B-cell non-Hodgkin's lymphoma. N Engl J Med 2008;359:613-626
Ardeshna KM, Smith P, Norton A, et al. Long-term effect of a watch and wait policy versus immediate systemic treatment for asymptomatic advanced-stage non-Hodgkin lymphoma: A randomised controlled trial. Lancet 2003;362:516-522 (Pubitemid 36976715)
Hainsworth JD, Litchy S, Burris HA 3rd, et al. Rituximab as first-line and maintenance therapy for patients with indolent non-hodgkin's lymphoma. J Clin Oncol 2002;20:4261-4267
Zelenetz AD. Radioimmunotherapy for lymphoma. Curr Opin Oncol 1999;11:375-380
** Kaminski MS, Tuck M, Estes J, et al. 131I-tositumomab therapy as initial treatment for follicular lymphoma. N Engl J Med 2005;352:441-449
Marcus R, Imrie K, Solal-Celigny P, et al. Phase III study of R-CVP compared with cyclophosphamide, vincristine, and prednisone alone in patients with previously untreated advanced follicular lymphoma. J Clin Oncol 2008;26:4579-4586
Hiddemann W, Kneba M, Dreyling M, et al. Frontline therapy with rituximab added to the combination of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) significantly improves the outcome for patients with advanced-stage follicular lymphoma compared with therapy with CHOP alone: Results of a prospective randomized study of the German low-grade lymphoma study group. Blood 2005;106:3725-3732 (Pubitemid 41742196)
Herald M, Haas A, Srock S, et al. Rituximab added to first-line mitoxantrone, chlorambucil, and prednisolone chemotherapy followed by interferon maintenance prolongs survival in patients with advanced follicular lymphoma: An East German study group hematology and oncology study. J Clin Oncol 2007;25: 1986-1992 (Pubitemid 46972781)
Hochster H, Weller E, Gascoyne RD, et al. Maintenance rituximab after cyclophosphamide, vincristine, and prednisone prolongs progression-free survival in advanced indolent lymphoma: Results of the randomized phase III ECOG1496 Study. J Clin Oncol 2009;27: 1607-1614
Morschauser F, Radford J, Van Hoof A, et al. Phase III trial of consolidation therapy with Yttrium-90-Ibritumomab Tiuxetan compared with to additional therapy after first remission in advanced follicular lymphoma. J Clin Oncol 2008;26:5156-5164
Sebban C, Mounier N, Brousse N, et al. Standard chemotherapy with interferon compared with CHOP followed by high-dose therapy with autologous stem cell transplantation in untreated patients with advanced follicular lymphoma: tTe GELF-94 randomized study from the Groupe d'étude des lymphomes de l'adulte (GELA). Blood 2006;108:2540-2544 (Pubitemid 44776986)
Hiddemann W, Unterhalt M, Wandt H, et al. Myeloablative radiochemotherapy followed by blood stem cell transplantation significantly prolongs the disease-free interval in patients with low-grade lymphomas as compared to standard maintenance with interferon alpha: results of a prospective randomized comparison by the german low-grade lymphoma study group. [abstract]. Blood 1999;96:610a.
Gyan E, Foussard C, Bertrand P, et al. High-dose therapy followed by autologous purged stem cell transplantation and doxorubicin-based chemotherapy in patients with advanced follicular lymphoma: A randomized multicenter study by the GOELAMS with final results after a median follow-up of 9 years. Blood 2009;113:995-1001.
Gordon LI, Witzig T, Molina A, et al. Yttrium 90-labeled ibritumomab tiuxetan radioimmunotherapy produces high response rates and durable remissions in patients with previously treated B-cell lymphoma. Clin Lymphoma 2004;5:98-101. (Pubitemid 39378319)
* Gisselbrecht C, Bethge W, Duarte RF, et al. Current status and future perspectives for yttrium-90 ((90)Y)-ibritumomab tiuxetan in stem cell transplantation for non-Hodgkin's lymphoma. Bone Marrow Transplant 2007;40:1007-1017