Lymphoma, follicular is a chronic and persistent disease of the lymphoid system, and is currently best treated with chemotherapy, especially CHOP and R-CHOP. There is no known risk factor for this disease.
About 8,000 people are diagnosed annually with newly diagnosed follicular lymphoma, which contributes to 4% of all lymphoid malignancies reported by the National Cancer Institute. The incidence of this disease may vary from one part of the United States to another.
Almost half of patients with follicular lymphoma, who received all standard-modality treatment, did not have disease-related deaths for 5 years. Survival rates at this point in time have improved by at least half compared with survival rates in the past. The increased response to treatment (as measured by survival) in follicular lymphoma is due to enhanced treatment.
Symptoms, signs, and symptoms of [follicular lymphoma](https://www.withpower.com/clinical-trials/follicular-lymphoma) are similar to those of malignancy. Lymphoma can be suspected in asymptomatic patients with signs that are suggestive of lymphoma. The diagnosis of malignancy should be sought in patients with symptoms. In asymptomatic patients, lymphoma may be diagnosed on the basis of B-cell morphology or on the presence of monoclonal paraproteins. Tumors and benign tumors can be difficult to distinguish in the bone marrow, peripheral nervous system, and orbit.
Lymphoma, follicular is an extraordinarily aggressive cancer. It is the most frequent unrelated cause of death from cancer in the young and is much more common among people of African descent.
Because patients with follicular lymphoma usually present to the medical community with one general symptom, treatment for symptomatic disease is often instituted. However, symptomatic disease is often treated with a combination of drugs, which is associated with a high relapse rate. Therefore, new therapies may be needed.
The addition of idelalisib to chemotherapy resulted in a significant improvement in PFS and OS versus chemotherapy alone in patients whose disease was progressing after at least 4 weeks of treatment. Most patients in the idelalisib-only arm had sustained improvement of their tumor burden, while patients who continued receiving the chemotherapy regimen had no progression. In responders the rate of progression to death or disease progression at time of last observation was 28% vs. 15% in nonresponders.
In spite of significant progress in the research on follicular malignancies, our patients who are afflicted with follicular lymphoma suffer relapses and succumb to further disease in most of them.
Only a small percentage of lymphoma patients survive longer than a year. The longest-surviving lymphoma patients currently reported in the literature have been treated with radiation and/or chemotherapy with a median survival in the range of 18 months. Because of the low frequency of long-term survival for follicular lymphoma, it may be prudent to consider adjuvant radiation therapy before chemotherapy. More research in this area is warranted.
Idelalisib administered at 600 mg twice daily in elderly patients with follicular lymphoma appears safe and well tolerated. We observed no significant differences in dose-limiting adverse events between elderly and non-elderly patients.
Idelalisib has shown a broad range of side effects in cancer patients, many of which have been reported in previous studies with [rituximab] and similar drugs. However, more studies are needed to further characterize these effects. For example, a more extensive postmarketing surveillance should be conducted.