Follicular Lymphoma: Relapsed/Refractory

The term “relapsed” refers to disease that reappears or grows again after a period of remission.

The term “refractory” is used to describe when the lymphoma does not respond to treatment or when the response to treatment does not last very long.

Although many patients go into a remission that lasts for years after their initial treatment, the disease can often return.

For patients who relapse or become refractory, second-line therapies (treatment given when initial therapy does not work or stops working) are often successful in providing another remission. Some patients who relapse do not need treatment right away, and an “active surveillance” (also known as “watch and wait” or “watchful waiting”) approach might be used. With this strategy, patients’ overall health and disease are monitored through regular checkup visits and various evaluating procedures, such as laboratory and imaging tests. Active treatment is started if the patient begins to develop lymphoma-related symptoms or there are signs that the disease is progressing based on testing during follow-up visits.

For those who need treatment, the same therapies used for newly diagnosed patients can often be used in patients with relapsed/refractory FL, but additional treatments are also available.

Treatment for relapsed/refractory FL is based on a patient’s age, overall health, symptoms, and the duration of remission from the last treatment they received. Chemotherapy, radiation, and monoclonal antibodies may be used to treat relapsed/refractory FL. Common second-line regimens include:

  • Bendamustine (Treanda) with or without rituximab (Rituxan) or obinutuzumab (Gazyva)
  • Copanlisib (Aliqopa)
  • Duvelisib (Copiktra)
  • Fludarabine (Fludara) and rituximab (Rituxan)
  • Idelalisib (Zydelig)
  • R² – rituximab and lenalidomide (Rituxan and Revlimid)
  • R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone)
  • R-CVP (rituximab, cyclophosphamide, vincristine, and prednisone)
  • R-FND (rituximab, fludarabine, mitoxantrone, and dexamethasone)
  • Rituximab
  • Rituximab and Hyaluronidase Human (Rituxan Hycela)

Although uncommon, radioimmunotherapy (RIT) using an agent such as yttrium-90 ibritumomab tiuxetan (Zevalin), which is a radioactive particle connected to an antibody that targets cancer cells, may also be used alone or in combination with chemotherapy to treat relapsed/refractory FL.

Bendamustine is approved for patients with indolent B-cell NHLs, like FL, whose disease is refractory to rituximab. Radiation therapy can be effective in some patients with relapsed/ refractory FL who have large tumors or disease symptoms. Often very low doses of radiation can be quite beneficial.

For some patients with relapsed/refractory FL, high-dose chemotherapy followed by stem cell transplantation may be an option.

To learn more about relapsed/refractory FL, download the Follicular Lymphoma – Relapsed / Refractory Fact Sheet.

See also:

Survey Opportunity for Follicular Lymphoma Patients: Our friends at Lymphoma Canada have developed a survey in order to learn more about follicular lymphoma patients and their experience with their treatment. Please click here to participate.