The Fellow on Call: The Heme/Onc Podcast Episode 138: Follicular Lymphoma Series, Pt 3 - Relapsed/Refractory Management (non-cellular therapy options)
Sep 10, 2025
The discussion dives into relapsed/refractory follicular lymphoma and explores non-cellular therapy options. It highlights the use of rituximab maintenance therapy and its impact on patient surveillance. The hosts analyze treatment choices for low-burden relapses, comparing lenalidomide combined with rituximab and traditional chemotherapy. Key insights include the importance of POD24 in prognosis and the clinical role of oral tazemetostat. The episode wraps up with a sneak peek into future discussions on bispecifics and CAR-T therapies.
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Rituximab Maintenance Tradeoffs
- Rituximab maintenance improves progression-free survival but not overall survival.
- It gives an absolute ~10% fewer patients needing therapy at 10 years, so decide individually with patients.
Individualize Maintenance Decisions
- Discuss maintenance candidly with patients and individualize decisions.
- Warn patients about infusion time and a doubled rate of severe infections on maintenance.
POD24 Is The Key Prognostic Marker
- POD24 (progression within 24 months after chemoimmunotherapy) is the strongest prognostic factor in FL.
- POD24 patients have much worse survival (about 50% vs 90% five‑year OS historically).