Minimizing Risk of Adverse Events and Transformation Among Patients With Follicular Lymphoma

Abhay Singh, MD, Cleveland Clinic, Cleveland, Ohio, shares his advice for fellow oncologists treating patients with follicular lymphoma (FL) in regard to the goal of minimizing the risk of adverse events and disease transformation to acute myeloid leukemia (AML)/myelodysplastic syndrome (MDS). 

Transcript:

Hi, my name is Abhay Singh. I'm one of the physicians in the Leukemia and Myeloid Disorders Program at the Cleveland Clinic. 

Oncology Learning Network: What advice do you have for fellow oncologists who are looking to minimize treatment-related adverse events among patients with follicular lymphoma?

I think what the treating oncologist can monitor is [whether] there [is] a true need for use of [granulocyte-colony stimulating factor] (G-CSF), because many times in practice we see that G-CSF is used for neutrophil counts of, let's say, [absolute neutrophil count] (ANC) of 0.5, 0.6 or 600, 700, and then we are pretty prompt to use G-CSF. 

It might be time to reconsider our practice where we may be exposing these patients to more harm and benefit. So certainly, if it can be avoided, there certainly should be a practice to avoid G-CSF exposure. Until we can gather more data, we are actively trying to gather more data to see if there [are] any molecular connections here.

If some of the patients have pre-existing mutations, then certainly there'll be indications for not using G-CSF. But, these studies need serial samples [and] longitudinal monitoring. [It] will take a while for them to happen. Until then, we just have to be judicious in our use of G-CSF. 

So, [this is] something to consider for our treating oncologists. I think more messages will go out once our manuscript [is] published officially. So, I think there's a lot more to learn. We have some exciting other findings as well that we'll be reporting.

Source: 

Herr M, Singh A, Hahn T, et al. Risk factors beyond chemotherapy exposure for therapy-related myelodysplastic syndrome (tMDS) and acute myeloid leukemia (tAML) development in lymphoma survivors: A 15-year SEER-medicare analysis. Clin Lymph Myel and Leuk. Published online: September 2023. doi: 10.1016/S2152-2650(23)00983-7