Clinical and prognostic tools to improve frontline management strategies in follicular lymphoma

2021 ◽  
Author(s):  
◽  
Joshua Tobin
Keyword(s):  
Follicular Lymphoma ◽  
Management Strategies

scholarly journals Initial management strategies for follicular lymphoma

2012 ◽  
Vol 1 (1) ◽  
pp. 35-45 ◽  
Author(s):  
Qiushi Chen ◽  
Turgay Ayer ◽  
Loretta J Nastoupil ◽  
Miray Seward ◽  
Hongzheng Zhang ◽  
...  
Keyword(s):  
Follicular Lymphoma ◽  
Management Strategies ◽  
Initial Management

scholarly journals Effectiveness of First-Line Management Strategies for Stage I Follicular Lymphoma: Analysis of the National LymphoCare Study

2012 ◽  
Vol 30 (27) ◽  
pp. 3368-3375 ◽  
Author(s):  
Jonathan W. Friedberg ◽  
Michelle Byrtek ◽  
Brian K. Link ◽  
Christopher Flowers ◽  
Michael Taylor ◽  
...  
Keyword(s):  
Follicular Lymphoma ◽  
Ct Scan ◽  
Systemic Therapy ◽  
Management Strategies ◽  
Imaging Study ◽  
Progression Free Survival ◽  
Stage I ◽  
Whole Body ◽  
Treatment Approaches ◽  
Positron Emission

PurposeThe optimal management of stage I follicular lymphoma, according to consensus guidelines, is based on uncontrolled experiences of select institutions. Diverse treatment approaches are used despite guidelines that recommend radiation therapy (XRT).Patients and MethodsWe analyzed outcomes of patients with stage I follicular lymphoma enrolled onto the National LymphoCare database.ResultsOf 471 patients with stage I follicular lymphoma, 206 patients underwent rigorous staging as defined by both a bone marrow aspirate and biopsy and an imaging study (a computed tomography [CT] scan of the whole body, a positron emission tomography [PET]/CT scan, or both). Rigorously staged patients had superior progression-free survival (PFS) compared with nonrigorously staged patients (hazard ratio [HR], 0.63). Treatments given to rigorously staged patients were rituximab/chemotherapy (R-chemo; 28%), XRT (27%), observation (17%), systemic therapy + XRT (13%), rituximab monotherapy (12%), and other (3%). With a median follow-up of 57 months for PFS, there were 44 progression events (in 21% of patients) for rigorously staged patients. For these patients, PFS was significantly improved with either R-chemo or systemic therapy + XRT compared with patients receiving XRT alone after adjustment for histology, LDH, and the presence of B symptoms. There were no differences in overall survival.ConclusionIn this largest, prospectively enrolled group of patients with stage I follicular lymphoma, variable treatment approaches resulted in similar excellent outcomes, which challenges the paradigm that XRT should be standard for this presentation.

scholarly journals Novel treatment approaches and future perspectives in follicular lymphoma

2019 ◽  
Vol 10 ◽  
pp. 204062071882051 ◽  
Author(s):  
Grerk Sutamtewagul ◽  
Brian K. Link
Keyword(s):  
Follicular Lymphoma ◽  
Checkpoint Inhibitors ◽  
Systemic Disease ◽  
Management Strategies ◽  
Progression Free Survival ◽  
Initial Therapy ◽  
Novel Therapies ◽  
Ongoing Research ◽  
Drug Conjugates ◽  
Anti Cd20

Follicular lymphoma (FL) is a common B-cell malignancy characterized by relatively indolent growth and incurability with an expected lifetime course of serial intermittent treatment courses. Many patients with FL have lives shortened by the disease and despite a relatively favorable prognosis relative to other incurable systemic malignancies, optimal management of FL has not been achieved. This review focuses on identifying both patients for whom novel therapies might be most beneficial as well as systematically reviewing novel strategies at various levels of investigation. Prognostic markers incorporating clinical measurements and tumor genetics are discussed, yet at the time of diagnosis do not yet powerfully discriminate patients for whom specific strategies are beneficial. Reassessment of prognosis after evaluating the response to initial therapy is the most powerful identifier of those in need of novel management strategies. For initial therapy of high burden systemic disease, anti-CD20 antibody along with chemotherapy or immunomodulators all offer relatively similar effects on overall survival with subtly different effects on progression-free survival and quality of life. Several new agents currently under investigation in the upfront setting are discussed. Perhaps the best testing ground for novel therapies is in patients with early relapse following initial immunochemotherapy. Ongoing research in multiple therapy classes including, novel monoclonal antibodies, antibody drug conjugates, immunomodulatory agents, intracellular pathway inhibitors, immune checkpoint inhibitors, and epigenetic regulators are discussed herein.

One Size Does Not Fit All: Who Benefits From Maintenance After Frontline Therapy for Follicular Lymphoma?

2019 ◽  
pp. 467-476 ◽  
Author(s):  
Mark Roschewski ◽  
Brian T. Hill
Keyword(s):  
Follicular Lymphoma ◽  
B Cell ◽  
Residual Disease ◽  
Management Strategies ◽  
Phase Iii ◽  
Advanced Stage ◽  
Ongoing Research ◽  
Depth Of Response ◽  
Frontline Therapy ◽  
Anti Cd20

Follicular lymphoma (FL) is the second most common non-Hodgkin lymphoma and the most common indolent B-cell malignancy. The disease often presents in advanced stage and can often be observed before initiation of therapy. Although the incidence is only approximately 15,000 new cases per year, the prevalence is substantially higher owing to the favorable overall survival (OS) of most patients. The most impactful advance responsible for the improvement of OS in FL was the introduction of the anti-CD20 monoclonal antibody (mAb) rituximab over 20 years ago. Phase III trials demonstrate that rituximab improves the OS in FL when combined with chemotherapy. However, unlike aggressive B-cell lymphomas, advanced stage FL is generally incurable and often displays a pattern of progressively shorter remissions with subsequent lines of therapy. Hence, maintenance strategies have been developed to prolong remissions achieved with frontline therapy. The value of maintenance after frontline therapy has been most extensively studied with extended treatment of anti-CD20 mAb, but recent approaches include chemotherapy-free combinations and targeted therapies given for extended durations. Here, we review relevant data that provide rationale in support of maintenance therapy in FL as well as the risks and limitations of a “one-size-fits-all” approach. Importantly, we note the biologic and clinical heterogeneity across patients with FL that must be considered when making clinical decisions. Finally, we highlight ongoing research that explores response-adapted approaches based on the depth of response as defined by PET scans and assays for minimal residual disease (MRD) that aim to better personalize individual management strategies.

Grade 3 Follicular Lymphoma Patients Can Experience Favorable Outcomes With Various Management Strategies

2017 ◽  
Vol 99 (2) ◽  
pp. E425-E426
Author(s):  
Z. Ayoub ◽  
T.Y. Andraos ◽  
S.A. Milgrom ◽  
C.C. Pinnix ◽  
B. Dabaja ◽  
...  
Keyword(s):  
Follicular Lymphoma ◽  
Management Strategies ◽  
Grade 3

scholarly journals Sequencing of therapies in relapsed follicular lymphoma

Hematology ◽  
2018 ◽  
Vol 2018 (1) ◽  
pp. 189-193
Author(s):  
Loretta J. Nastoupil ◽  
Christopher R. Flowers ◽  
John P. Leonard
Keyword(s):  
Follicular Lymphoma ◽  
Treatment Options ◽  
Management Strategies ◽  
Unmet Need ◽  
Treatment Decisions ◽  
Treatment Modalities ◽  
Patient Specific ◽  
Related Factors ◽  
Care Plans ◽  
Molecular Features

Abstract Follicular lymphoma (FL) is an incurable but treatable disease with vast treatment options. Despite the abundance of efficacious treatment modalities, there is no universally agreed upon standard approach to treatment, particularly in the relapsed/refractory setting. There is an increasing need for more robust and clinically available tools to risk-stratify patients and identify those likely to experience early relapse, which is currently recognized as the unmet need in FL. Additionally, the use of gene-expression profiling and next-generation sequencing techniques in recent years has led to a wealth of knowledge regarding the molecular drivers of lymphomagenesis. However, much of this knowledge is not currently available in the clinic to inform treatment decisions. Future studies are needed to generate clinically relevant predictive models adept at incorporating patient-specific and molecular features to inform management strategies along the entire disease continuum as treatment decisions should not be made in a vacuum with a one-size-fits-all approach. Sequencing of therapy in the management of relapsed FL should involve personalized decision-making for care plans that balance patient characteristics, preferences, and comorbidities with treatment-related factors such as efficacy, toxicity profile, and mechanisms of action to achieve a durable, quality remission.

Improving Speech and Language Services through Effective Time Management

1983 ◽  
Vol 14 (2) ◽  
pp. 86-91 ◽  
Author(s):  
Barbara W. Travers
Keyword(s):  
Time Management ◽  
Management Strategies ◽  
Federal State ◽  
Speech Language Pathologist ◽  
School Based ◽  
Work Area ◽  
Paper Work ◽  
Areas Of Concern ◽  
State And Local ◽  
Therapeutic Services

This paper presents strategies for increasing the effectiveness and efficiency of the school-based speech-language pathologist. Various time management strategies are adapted and outlined for three major areas of concern: using time, organizing the work area, and managing paper work. It is suggested that the use of such methods will aid the speech-language pathologist in coping with federal, state, and local regulations while continuing to provide quality therapeutic services.

A Case Study: Unique Challenges of an Adolescent Female With Autism Spectrum Disorder

2020 ◽  
Vol 5 (1) ◽  
pp. 314-325
Author(s):  
Kimberly F. Frazier ◽  
Jessica Collier ◽  
Rachel Glade
Keyword(s):  
Autism Spectrum Disorder ◽  
Cognitive Abilities ◽  
Social Cognitive ◽  
Social Performance ◽  
Management Strategies ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Self Management ◽  
Adolescent Female ◽  
Social Thinking

Background The aim of this study was to determine the clinical efficacy of combining self-management strategies and a social thinking approach to address the social performance and executive function of an adolescent female with autism spectrum disorder. Method This research examined the effects of a social knowledge training program, “Think Social,” as well as strategies to improve higher order cognitive abilities. Results and Conclusion Although quantitative improvement was not found, several qualitative gains in behavior were noted for the participants of this study, suggesting a benefit from using structured environmental cues of self-management strategies, as well as improved social understanding through social cognitive training.

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