Chemotherapy-Free Management of Follicular and Marginal Zone Lymphoma
Thomas A Ollila,1,2 Adam J Olszewski1,2 1Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA; 2Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USACorrespondence: Adam J OlszewskiDepartment of Medicine, Alpert Medical School of Brown Universi...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2021-05-01
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| Series: | Cancer Management and Research |
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| Online Access: | https://www.dovepress.com/chemotherapy-free-management-of-follicular-and-marginal-zone-lymphoma-peer-reviewed-fulltext-article-CMAR |
| _version_ | 1818945164962430976 |
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| author | Ollila TA Olszewski AJ |
| author_facet | Ollila TA Olszewski AJ |
| author_sort | Ollila TA |
| collection | DOAJ |
| description | Thomas A Ollila,1,2 Adam J Olszewski1,2 1Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA; 2Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USACorrespondence: Adam J OlszewskiDepartment of Medicine, Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy St., Providence, RI, 02903, USATel +1 844-222-2881Fax +1 401-444-8918Email adam_olszewski@brown.eduAbstract: Many patients with follicular (FL) or marginal zone lymphoma (MZL) are not eligible to receive immunochemotherapy due to advanced age or comorbidities. Recent innovations in the treatment of these indolent lymphomas provide options for multiple lines of chemotherapy-free management. More research is needed to determine which older patients are best served by a chemotherapy-free approach in the context of geriatric vulnerabilities. In the first line, regardless of disease burden, rituximab monotherapy can provide high rates of disease control with minimal toxicity, while judicious use of brief maintenance extends the duration of response. Radioimmunotherapy using ibritumomab tiuxetan is an effective and safe post-rituximab consolidation for older patients who have < 25% bone marrow involvement. The combination of rituximab and lenalidomide, although “chemotherapy-free”, does not improve tolerability over immunochemotherapy. However, studies support lower doses and shorter duration of lenalidomide exposure as a means to improve safety without materially compromising efficacy for older individuals. Extranodal MZL can often be effectively controlled with low-dose radiation therapy, and splenic MZL has excellent outcomes with rituximab monotherapy. For many patients with relapsed FL/MZL, simple retreatment with anti-CD20 antibodies will prove sufficient. Other currently available options for relapsed/refractory disease include ibritumomab tiuxetan, lenalidomide with rituximab, umbralisib as a potentially less toxic PI3K inhibitor, ibrutinib (for MZL), and tazemetostat (for FL, especially with EZH2 mutation). Emerging data with novel forms of immunotherapy (antibody-drug conjugates like polatuzumab vedotin or loncastuximab tesirine; T-cell-engaging bispecific antibodies like mosunetuzumab or epcoritamab; and chimeric antigen receptor CAR T-cells like axicabtagene ciloleucel) suggest that immune-directed approaches can produce very high and potentially durable responses in FL/MZL with limited toxicities, further obviating the need for chemotherapy.Keywords: follicular lymphoma, marginal zone lymphoma, geriatric oncology, lenalidomide, ibritumomab tiuxetan, bispecific antibodies |
| first_indexed | 2024-12-20T07:54:46Z |
| format | Article |
| id | doaj.art-6439d6433f4d4796b75f19f9930b5f52 |
| institution | Directory Open Access Journal |
| issn | 1179-1322 |
| language | English |
| last_indexed | 2024-12-20T07:54:46Z |
| publishDate | 2021-05-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Cancer Management and Research |
| spelling | doaj.art-6439d6433f4d4796b75f19f9930b5f522022-12-21T19:47:45ZengDove Medical PressCancer Management and Research1179-13222021-05-01Volume 133935395264774Chemotherapy-Free Management of Follicular and Marginal Zone LymphomaOllila TAOlszewski AJThomas A Ollila,1,2 Adam J Olszewski1,2 1Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA; 2Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USACorrespondence: Adam J OlszewskiDepartment of Medicine, Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy St., Providence, RI, 02903, USATel +1 844-222-2881Fax +1 401-444-8918Email adam_olszewski@brown.eduAbstract: Many patients with follicular (FL) or marginal zone lymphoma (MZL) are not eligible to receive immunochemotherapy due to advanced age or comorbidities. Recent innovations in the treatment of these indolent lymphomas provide options for multiple lines of chemotherapy-free management. More research is needed to determine which older patients are best served by a chemotherapy-free approach in the context of geriatric vulnerabilities. In the first line, regardless of disease burden, rituximab monotherapy can provide high rates of disease control with minimal toxicity, while judicious use of brief maintenance extends the duration of response. Radioimmunotherapy using ibritumomab tiuxetan is an effective and safe post-rituximab consolidation for older patients who have < 25% bone marrow involvement. The combination of rituximab and lenalidomide, although “chemotherapy-free”, does not improve tolerability over immunochemotherapy. However, studies support lower doses and shorter duration of lenalidomide exposure as a means to improve safety without materially compromising efficacy for older individuals. Extranodal MZL can often be effectively controlled with low-dose radiation therapy, and splenic MZL has excellent outcomes with rituximab monotherapy. For many patients with relapsed FL/MZL, simple retreatment with anti-CD20 antibodies will prove sufficient. Other currently available options for relapsed/refractory disease include ibritumomab tiuxetan, lenalidomide with rituximab, umbralisib as a potentially less toxic PI3K inhibitor, ibrutinib (for MZL), and tazemetostat (for FL, especially with EZH2 mutation). Emerging data with novel forms of immunotherapy (antibody-drug conjugates like polatuzumab vedotin or loncastuximab tesirine; T-cell-engaging bispecific antibodies like mosunetuzumab or epcoritamab; and chimeric antigen receptor CAR T-cells like axicabtagene ciloleucel) suggest that immune-directed approaches can produce very high and potentially durable responses in FL/MZL with limited toxicities, further obviating the need for chemotherapy.Keywords: follicular lymphoma, marginal zone lymphoma, geriatric oncology, lenalidomide, ibritumomab tiuxetan, bispecific antibodieshttps://www.dovepress.com/chemotherapy-free-management-of-follicular-and-marginal-zone-lymphoma-peer-reviewed-fulltext-article-CMARfollicular lymphomamarginal zone lymphomageriatric oncologylenalidomideibritumomab tiuxetanbispecific antibodies |
| spellingShingle | Ollila TA Olszewski AJ Chemotherapy-Free Management of Follicular and Marginal Zone Lymphoma Cancer Management and Research follicular lymphoma marginal zone lymphoma geriatric oncology lenalidomide ibritumomab tiuxetan bispecific antibodies |
| title | Chemotherapy-Free Management of Follicular and Marginal Zone Lymphoma |
| title_full | Chemotherapy-Free Management of Follicular and Marginal Zone Lymphoma |
| title_fullStr | Chemotherapy-Free Management of Follicular and Marginal Zone Lymphoma |
| title_full_unstemmed | Chemotherapy-Free Management of Follicular and Marginal Zone Lymphoma |
| title_short | Chemotherapy-Free Management of Follicular and Marginal Zone Lymphoma |
| title_sort | chemotherapy free management of follicular and marginal zone lymphoma |
| topic | follicular lymphoma marginal zone lymphoma geriatric oncology lenalidomide ibritumomab tiuxetan bispecific antibodies |
| url | https://www.dovepress.com/chemotherapy-free-management-of-follicular-and-marginal-zone-lymphoma-peer-reviewed-fulltext-article-CMAR |
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