Refractory Follicular Lymphoma Case Study

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Relapsed/Refractory Follicular Lymphoma Response Evaluation
By Liji Thomas, MD
Relapsed or refractory follicular lymphoma (FL) is a condition that requires a careful selection of treatment options. It often occurs in older people, who may have significant comorbidities, or who may have more advanced grades or stages of the cancer.
Various treatment schedules are thus used in relapsed or refractory lymphoma, which must be evaluated for evidence and amplitude of response. This may begin with imaging, which should be carried out in the middle and at the completion of the chemotherapy. The midterm response will confirm whether the treatment efficacy is as desired. If there is less than a partial response, an early salvage regimen should be substituted if possible. On the other hand, if there is partial response, such patients may be put on rituximab for maintenance, which may produce a complete response.
PET for evaluation
A combination of positron emission tomography (PET) and computerized tomography (CT) is helpful to assess the prognosis. Patients who remain PET positive for a long time are at a higher risk for refractory
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It reflects the tumor sensitivity to treatment. It has been shown in trials to indicate long-term outcome with accuracy, but is not yet in clinical use because a negative MRD is not associated with any survival advantage. Patients who have undergone stem cell transplantation but have residual MRD have a poorer prognosis. For instance, when the polymerase chain reaction was negative at the end of treatment, it was termed complete molecular remission and was associated with a better outcome, the 7-year progression-free survival being 58% vs. only 36% in patients who had minimal residual disease. In fact, patients with MRD showed no difference whether or not they were on maintenance

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