Some people may respond well to their first treatment, but after a period of time, their disease returns, this is known as relapse. Sometimes they don’t respond well to their first treatment and this is known as refractory disease. For patients who have relapsed follicular lymphoma (FL), there are a number of other treatments that your oncologist/hematologist will consider. Although relapse is common, it is upsetting. Most people with FL relapse several times and have different treatments during the course of their illness.
Typical signs of a relapse include symptoms similar to when you were diagnosed, such as new rapidly growing nodes or so-called “B” symptoms such as drenching night sweats, fevers and unexplained weight loss.
Although many patients can have a remission that lasts many years after their initial treatment for FL – the disease is expected to return. In a small number of cases FL can become more aggressive or transform (change). If this is the case, keep reading to learn more about possible treatment options.
Watch this short clip where Dr Mitchell Smith, Chief Medical Officer at the FLF, answers a question on whether repeat treatments may be needed if FL returns (relapses).
Are you or a loved one wondering what to look out for if your FL returns or facing the challenges of a relapse?
Please watch our informative, and empowering webinar that brings together leading experts and a patient speaker to provide a comprehensive view of managing this complex stage of the disease.
Whether you’re a patient, caregiver, or healthcare professional, this webinar is designed to provide you with the critical knowledge and tools you need to make informed decisions about relapsed follicular lymphoma.
It’s possible that after diagnosis with FL, the disease can transform from an indolent low-grade lymphoma into a faster-growing type of lymphoma like Diffuse Large B Cell Lymphoma (DLBCL). This will need to be treated more aggressively like a high-grade lymphoma. Although the exact incidence of transformation is not well defined, it does seem to have reduced with modern treatments. A range of new treatments effective against DLBCL, many of which also work against FL, such as CART and bispecific antibodies, are helping improve the outcomes for patients whose disease has transformed. Clinical trials may be an important option to explore.
You may notice a change in your symptoms such as your lymph nodes increasing in size, new lymph nodes or a change in organs such as the spleen. There might also be evidence of ‘B symptoms’ which include drenching night sweats, fever, losing weight. There may be indications of signs of transformation from your blood test, which will show an increase in certain proteins in the blood such as lactate dehydrogenase (known as LDH).
If transformation is suspected, the Doctor will arrange for a scan such as a CT or PET scan and arrange to take a biopsy to confirm if the cells are growing at a faster rate.
There is currently no standard way in which relapsed, refractory or transformed FL is treated. Some treatments are also not available across all countries and regions. Your doctor will take the following factors into account:
Once these factors are taken into account, a range of options may be considered, as outlined below.
Depending on your country of residence, your doctor may recommend an alternative treatment combination which will differ from what you will have had previously. This may involve a combination of immunotherapy and chemo together with maintenance, and Rituximab. In certain cases, stem cell transplants may be an appropriate option (see below).
Broad classes of treatments include chemotherapy, immunotherapies such as CART and bispecific antibodies, antibody-drug conjugates, immune modulation such as lenalidomide, cell growth blockers such as BTK inhibitors and epigenetic modifiers such as tazemetostat.
For more information on specific treatments, click here, and for immunotherapy, click here.
Stem cells are ‘seed’ cells that live in the bone marrow. When they grow they turn into many different types of blood cells including the cells in our immune system that are vital for our survival. When a patient has undergone cycles of high-dose chemotherapy, not only does it destroy the disease but it also destroys precious blood stem cells that need to be replaced. A stem cell transplant is necessary to ensure that the bone marrow is repopulated with healthy blood stem cells following this kind of chemo. The new blood cells then help to boost and rebuild your body’s own blood and immune system.
If your disease returns very quickly after your first treatment (commonly referred to as early relapse), your doctor may consider using a more intensive treatment (also known as ‘Salvage chemotherapy’). If you have a good response to this, then it will normally be followed by an autologous stem cell transplant.
Having a transplant is demanding both physically and emotionally. Your doctor will carefully consider your age, general health and condition of your marrow before deciding if you are a suitable candidate to use your own stem cells, or if you would benefit from receiving donated stem cells.
As part of your preparation you might have chemotherapy to get rid of as many cancer cells as possible. This chemotherapy might also help the bone marrow make more stem cells.
For some people, transplants are the only option that offers the chance of having a long term remission and survival. High doses of chemotherapy may mean that you have low numbers of blood cells for some time and are at risk of picking up infections.
You may need to stay in hospital until your blood cells have recovered enough to go home or you no longer have side effects. This can take up to 3-4 weeks.
There are two types of transplants: autologous and allogeneic transplants:
This is where a patient uses their own stem cells which are collected in advance and returned to them after they have received high doses of chemotherapy.
This procedure is more complicated than an autologous transplant and carries more risk. The stem cells are donated by another person who is genetically matched to the patient with the aim of suppressing the disease and restoring the patient’s immune system. The doctor will discuss with you the risk versus the benefits and because of the intense nature of this type of treatment, it is normally reserved for younger and fitter patients.
Watch this short clip and listen to Dr Mitchell Smith, Chief Medical Officer at the FLF, answer a question on autologous stem cell treatment.
Join us for an informative webinar where expert clinicians and individuals living with FL come together to discuss the signs, treatment options, and what to expect.
Whether you’re navigating FL yourself, or supporting or caring for a loved one, this session will provide vital knowledge, expert guidance, and a personal story of resilience. Connect with others through this engaging discussion and ask your questions.
