follicular lymphoma

Question 1

follicular lymphoma background

Answer 1

indolent cancer
late presenting
present with painless peripheral adenopathy in the cervical, axillary, inguinal, and/or femoral regions

A translocation between chromosome 14 and 18 results in the overexpression of the bcl-2 gene.

Question 2

Staging

Answer 2

limited stage
stage 1 - single node
stage 2 - multi node same side of diaphragm
stage 3 - multi node both sides of diaphragm
stage 4 - metastatic disease

most flollicular lymphomas are stage 3/4 at presentation

Question 3

treatment

Answer 3

stage 1 - radiotherapy. can be curative (50%)
stage 2- variable. radiotherapy / chemotherapy
stage 3/4 - chemotherapy once symptomatic

rituximab and CHOP
rituximab maintenance

novel treatments

***Bendamustine - replaces CHOP. better results, less toxicity

Lenalidomide
currently in trial

Question 4

Bendamustine

Answer 4

acts as an alkylating agent causing intra-strand and inter-strand cross-links between DNA bases

can be used with rituximab for treatment of follicular lymphoma

Question 5

Lenalidomide

Answer 5

three main activities: direct anti-tumor effect, inhibition of angiogenesis, and immunomodulation

side effect: teratogenic, brother of thalidomide