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2016 ; 8
(1
): e2016061
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Novel Drugs in Follicular Lymphoma
#MMPMID27872741
Anastasia A
; Rossi G
Mediterr J Hematol Infect Dis
2016[]; 8
(1
): e2016061
PMID27872741
show ga
Follicular lymphoma(FL) is the most common indolent non-Hodgkin lymphoma and
constitutes 15% to 30% of lymphoma diagnoses. The natural history of the disease
is characterized by recurrent relapses and progressively shorter remissions with
a median survival of 10yrs. The impossibility of achieving a definite cure, have
prompted investigations into the possible role of more active and less toxic
strategies with innovative therapeutic agents. Recently Casulo et al.
demonstrated that approximately 20% of patients with FL relapse within two years
after achieving remission with R-CHOP and have a poor prognosis. It is
conceivable that this particularly chemoresistant population would benefit from
specifically targeting the biologic and genetic factors that likely contribute to
their poor prognosis. Evolving strategies for difficult to treat FL patients have
recently considered immunomodulatory agents, new monoclonal antibodies as well as
drugs targeting selective intracellular pathways. The importance of targeting the
microenvironment together with the malignant FL cell has been particularly
underscored. We review the most promising approaches, such as combining anti-CD20
antibodies with immunomodulatory drugs (Lenalidomide), mAbs directed against
other surface antigens such as CD22 and CD23 (Epratuzumab, Lumiliximab),
immunomodulatory antibodies such as PD-1, or inhibitors of key steps in the
B-cell receptor pathway signaling such as PI3K inhibitors (Idelalisib,
Duvelisib). Another highly attractive approach is the application of the
bi-specific T-cell engaging (BiTE) antibody blinatumomab which targets both CD19
and CD3 antigens. Moreover, we highlight the potential of these therapies, taking
into account their toxicity. Of course, we must wait for Phase III trials results
to confirm the benefit of these new treatment strategies toward a new era of
chemotherapy-free treatment for follicular lymphoma.
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