Rituximab in the Management of Follicular Lymphoma
YL Kwong
Hong Kong J Radiol 2011;14(Suppl):S63-8
The incidence of follicular lymphoma, a low-grade malignant B-cell lymphoma, is increasing in most Asian populations. Follicular lymphoma is generally considered to be indolent with a life expectancy of approximately 10 to 14 years. However, it is characterised by repeated relapse, and disease progression typically occurs 3 to 5 years after initial treatment. Rituximab, a monoclonal antibody, demonstrates consistent survival benefits when administered as part of a first- and second-line immunochemotherapy. Consequently, rituximab is now considered the standard of care for follicular lymphoma, and is recommended as the first-line therapy for earlystage asymptomatic disease. Available evidence also demonstrates survival benefits for rituximab as maintenance therapy in patients who have responded to induction therapy with either frontline rituximab or chemotherapy. Improved survivals in patients receiving rituximab-based first-line induction and maintenance therapies suggest that this treatment strategy may be preferable to adopting a watch-and-wait policy in patients with asymptomatic follicular lymphoma. While rituximab has improved treatment outcomes in follicular lymphoma patients, the appropriate timing, dosing and duration of therapy remain to be clarified in future clinical trials. Given the indolent nature of follicular lymphoma and the relatively long life expectancy associated with this disease, prognostic tools have an important role in guiding clinical decisions based on individual patient risk.
中文摘要
Rituximab治療濾泡性淋巴瘤
YL Kwong
本濾泡性淋巴瘤是一種惡性度較低的B細胞腫瘤，其病發率在大多數亞洲國家中不斷上升。濾泡性 淋巴瘤病情緩慢，患者生存期約為10至14年。可是患病期間會不斷復發，患者一般會在首次治療後 3至5年出現病情惡化。Rituximab是一種單克隆抗體，作為一線及二線的免疫化療可改善病人存活 期，所以它被用作濾泡性淋巴瘤的標準治療，亦被推介為治療早期無症狀的濾泡性淋巴瘤的一線藥 物。現有的證據顯示患者對rituximab或化療的引導治療出現療效後，再接受rituximab作為維持治療也 可以改善病人存活期。這情況亦顯示此治療策略對於無症狀的濾泡性淋巴瘤患者來說，比採取觀望 措施較為可取。雖然rituximab可改善濾泡性淋巴瘤患者的病情，可是對於施予的時間、使用劑量的 多少，以及療程的長短，都須要日後作進一步的探討與臨床研究。由於濾泡性淋巴瘤的病情較為緩 慢，患者的生存期相對較長，預後工具對根據患者個人風險而做的臨床決策有重要作用。