Mitigating Risk of Transformation Among Patients With Follicular Lymphoma

Kiran Kumar, MD, MBA, UT Southwestern Medical Center, Dallas, Texas, discusses strategies for mitigating tumor burden and risk of transformation among patients with follicular lymphoma (FL), particularly for those with early-stage or limited disease. 

Transcript: 

My name's Kiran Kumar. I'm an Assistant Professor of radiation oncology at UT Southwestern Medical Center in Dallas. 

Oncology Learning Network: What treatment methods are you and other oncologists implementing to help mitigate the transformation of follicular lymphoma to diffuse large B-cell lymphoma (DLBCL)?

Follicular lymphoma and low-grade indolent lymphomas are complicated diseases. So, minimizing the tumor burden is what most believe can reduce the risk of transformation. When you have early-stage or limited disease for follicular lymphoma, doing some sort of definitive treatment, like definitive involved site radiation, for example, where you're getting rid of all the active disease, can reduce the risk of transformation. When you have a more diffuse or advanced stage, then treatment with chemoimmunotherapy is our first line of treatment. 

Usually something like BR—bendamustine and rituximab—but there are a lot of different regimens that can be used. So, usually, the best way to reduce the risk of transformation is by trying to reduce the bulk of disease.

In your opinion, what does the future of follicular lymphoma treatment look like?

I think there's a lot going on in terms of novel types of immunotherapies and different targeted therapies. One thing that's exciting is now [chimeric antigen receptor] (CAR) T[-cell therapy] is FDA-approved for follicular lymphoma. We are using CAR T-cell therapy for follicular lymphoma and we think that this will hopefully revolutionize the treatment, and it's currently being used off protocol and on a lot of studies that are ongoing.

Source:

Kumar KA, Ravella R, Ramakrishnan Geethakumari P, et al. Phase I trial of ‘re-priming’ radiation therapy for relapsed/refractory non-Hodgkin lymphoma patients in incomplete response after chimeric antigen receptor t-cell (CAR-T) therapy. Int Journal of Radiation Oncol. Published online: October 1, 2023. doi:10.1016/j.ijrobp.2023.06.334