Treatment of Follicular Lymphoma at Second or Subsequent Relapse
Clinical Scenario
This protocol addresses follicular lymphoma in patients who have experienced a second or subsequent relapse — a setting where prior treatment history, mechanisms of action, and the risk of cross-resistance all inform the choice of next therapy.
Approach Overview
At second or subsequent relapse, management draws on several distinct therapeutic categories. Preference is given to options not previously used and carrying different mechanisms of action. Patient-specific factors — including prior exposures and functional status — further guide selection among the available approaches.
Full regimen details, eligibility criteria, and complete sequencing are in the structured protocol →
References
DOI: 10.3390/cancers18030395
- Second or subsequent relapses can be treated with the following options (preferably if not previously used):
- Thus, options in this setting include a different immunochemotherapy regimen from that used in the first line (1C), R2 (1B) in lenalidomide naïve-patients, or rituximab monotherapy, especially in frail patients (2A), followed by maintenance therapy with rituximab in sensitive patients (1B).
- Tafasitamab-R2 in lenalidomide naïve-patients (2B).
- Zanubrutinib-obinutuzumab (2B).
- Bispecific antibodies: epcoritamab or mosenutuzumab (1B).
- CAR T-cell therapy (tisagenlecleucel in ≥ third line; axicabtagene ciloleucel in ≥ fourth line) (1B).
- Allogeneic transplantation can be considered in young patients with good functional status and without relevant comorbidities, who have relapsed after ASCT, CAR T-cell therapy, and bispecific antibodies, and who have achieved at least a partial response (PR) after rescue treatment (2C).
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