Director of the Lymphoma Program and Medical Director of the Oncology Data Center in the Department of Hematology and Oncology at Winship Cancer Institute of Emory University
Would you briefly describe Follicular Lymphoma?
Follicular lymphoma (FL) is an indolent, meaning slow-growing, lymphoma that is variable in its course. Many patients will not require active treatment, but others have disease that transforms into a more aggressive lymphoma. In patients who are treated, the disease can remain dormant, or in remission, for long periods of time, but it is characterized by relapses.
How common is Follicular Lymphoma?
It is one of the most common types of non-Hodgkin lymphoma (NHL), accounting for approximately 20 percent to 30 percent of all NHLs.
How is Follicular Lymphoma typically treated?
Treatments vary dramatically depending on the symptoms and stage at presentation. The average age of patients who are diagnosed is 60 or 70 years, and age often has an impact on treatment selection. At various points in the course of disease management an physician can use “watchful waiting,” immunotherapy, radioimmunotherapy (such as Bexxar or Zevalin), or combination treatments like rituximab (Rituxan) and chemotherapy, depending on many factors, including not only age, but a patient’s overall health.
For example, in patients with low-risk FL, we use “watchful waiting,” and for patients with local, or stage 1 disease, radiation therapy is often used.
What are the current main areas of research for Follicular Lymphoma?
There are various trials underway that are examining new drugs and new drug combinations. Several new agents that interfere with B-cell receptor signaling include ibrutinib and idelalisib (GS-1101, formerly CAL-101). Some other novel strategies include PD1 combination antibodies. There are also a number of new combinations of agents being studied in the relapsed setting, such as a US-led trial (ECOG 2408) investigating the use of bendamustine (Treanda) and rituximab with or without bortezomib (Velcade). This trial also examines a new strategy for maintenance therapy with the combination of lenalidomide (Revlimid) and rituximab.
Can you talk about the importance of clinical trials and are there any specific trials you wish to discuss?
Clinical trials are very important and should be considered for all patients with FL and any other type of cancer that is not commonly cured with standard therapy. Patients in clinical trials receive state-of-the art care and may be given drugs that are not yet available and represent promise beyond the current standard of care. In some trials these new therapies are compared with the standard therapy. All clinical trials are associated with some risk, so patients must be well informed before participating. Patients’ participation in clinical trials provides investigators with efficacy and safety data that are critical for advances in cancer care. These data provide new insights into the management of the disease and can lead to new drugs that become available for the treatment of others.
What advice would you give to a newly diagnosed patient?
It is extremely important to distinguish FL as a subset of NHL because the treatments for FL can be different than the treatments for other NHL types. For newly diagnosed patients, I recommend that they have their diagnosis confirmed by an expert hematopathologist. Once the diagnosis is confirmed, it is important for patients to find an expert who treats FL so he/she can evaluate the standard of care options and the clinical trial options, including all emerging therapies, so the best treatment is selected.
How are you involved with the Lymphoma Research Foundation and why would you recommend the patient become involved with the Lymphoma Research Foundation?
The Lymphoma Research Foundation is premier in patient education and support and is a wealth of information for patients (both online and in print). They are the key organization dedicated to supporting researchers and other experts to identify new therapies for lymphoma. I have been involved with the LRF on the local level as a speaker and fundraiser for Atlanta-area events including the Lymphomathons. I also serve on the LRF national Scientific Advisory Board (SAB) reviewing grants and developing educational materials. The SAB is now involved in an exciting new initiative to help increase the pool of well-trained lymphoma research. By far the highlight of my involvement with the LRF has been speaking at local and national patient education events. Talking to patients and caregivers about lymphoma, answering their questions, and sharing with them the new breakthroughs in the understanding of the disease is truly invigorating and each time renews my desire to get back to work to search for a cure.
Updated March 20, 2013