The Lynx Group
Interview with the Innovators

Relapsed/Refractory Follicular Lymphoma

Predicting High-Risk Disease Using Progression of Disease in 24 Months (POD24) and the Key Role of Repeat Biopsy to Exclude the Diagnosis of Transformation to a High-Grade Lymphoma in Patients with Relapsed Follicular Lymphoma
Dr Andrew Zelenetz explains the basis for the currently nearly universal use of the end point of “progression of disease in 24 months” (POD24) as a metric in patients with relapsed follicular lymphoma (FL) to identify a high-risk subpopulation. He also discusses how POD24 impacts the choice of therapy and assessing the impact of the next line of therapy. Dr Tycel Phillips emphasized the importance of repeat biopsy in patients with relapsed or refractory FL, to exclude the presence of histologic transformation of FL into a high-grade diffuse large B-cell lymphoma, which necessitates expeditious detection, staging, and aggressive therapy.
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Broadening the Variety of Candidate Therapies for R/R Follicular Lymphoma Allows Optimal Personalized Rx Choice, While Patient-Directed Education Helps Attain Greatest Clinical Benefit
Dr Tycel Phillips debates the importance of having more effective and better tolerated treatments for patients who present with recurrent or treatment-refractory follicular lymphoma (FL). Often, these patients have undergone more than 1 or 2 previous lines of therapy and cannot tolerate all types of therapies within the gamut of potential choices. In such patients, it is desirable to have flexibility in the choice of a therapy regimen, for example, one that is chemotherapy-free. Ms Peg Rummel commented that oncology nurses and nurse navigators are paramount in educating the patients and their caregivers around all aspects of therapy, and help alleviate psychological stress, anxiety, and fear of the unknown by explaining to patients with relapsed or refractory FL the various paths along their therapeutic journey.
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Criteria Used to Guide Treatment Decisions and Choice of Therapeutic Agents in Patients with Relapsed or Refractory Follicular Lymphoma
Dr Andrew Zelenetz examines the various criteria used in individual patients with relapsed or treatment-refractory follicular lymphoma and how they help determine the trigger for and timing of initiating antitumor therapies. Dr Tycel Phillips expands on how applying such criteria may best guide the oncologist to choose specific treatment options, such as certain classes of currently available (FDA-approved) drugs in monotherapy or in combination, especially in a community-based clinical setting.
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Specific Dysregulation of B-Cell Signaling in Follicular Lymphoma and Its Role in the Initiation and Progression of This Malignancy
Drs Andrew Zelenetz and Tycel Phillips explore the role B-cell signaling plays in the development and progression of follicular lymphoma (FL) and explain how this underlies the pathophysiology of FL. These biological mechanisms underlie the way that FL differs from other B-cell malignancies, and, in many ways, help select candidate molecular targets for the development of novel agents for the management of FL.
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Spectrum of Symptoms in Patients Newly Diagnosed with Follicular Lymphoma and the Role of Optimal Coordination of Care at Initial Presentation
Dr Andrew Zelenetz presents key aspects of the epidemiology of, and currently achieved survivorship in, follicular lymphoma (FL) and compares them with those seen in more commonly diagnosed malignancies treated by the broader group of community-based medical oncologists. Dr Tycel Phillips comments on the paucity of patient features or disease attributes that would help predict poor clinical outcomes, including reduced survival, when FL patients are evaluated at the time of initial diagnosis.
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Epidemiology and expected survivorship in follicular lymphoma and lack of reliable long-term outcome predictors at disease presentation
Dr Andrew Zelenetz presents key aspects of the epidemiology of, and currently achieved survivorship in, follicular lymphoma (FL) and compares them with those seen in more commonly diagnosed malignancies treated by the broader group of community-based medical oncologists. Dr Tycel Phillips comments on the paucity of patient features or disease attributes that would help predict poor clinical outcomes, including reduced survival, when FL patients are evaluated at the time of initial diagnosis.
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