From the Guidelines
The patient's progress with retroperitoneal non-Hodgkin B cell stage 1 Follicular lymphoma should be followed up with clinical evaluations every 3-6 months for 5 years, or as clinically indicated, with a focus on monitoring for signs of transformation or disease progression, as recommended by the National Comprehensive Cancer Network guidelines 1.
Key Components of Follow-up
- Regular clinical evaluations to monitor for symptoms, threatened end-organ function, cytopenia secondary to lymphoma, bulky disease, steady progression, or patient preference for treatment
- Imaging studies, such as CT scans of the chest, abdomen, and pelvis, to monitor the primary disease site and detect potential relapse
- Blood tests, including complete blood count, comprehensive metabolic panel, and lactate dehydrogenase, to monitor for signs of disease progression
- Consideration of PET-CT scans to assess treatment response, but not typically part of routine surveillance
- Bone marrow biopsies may be repeated if initially positive or if there are signs of disease progression
Importance of Monitoring
Monitoring for retroperitoneal stage 1 follicular non-Hodgkin B-cell lymphoma is crucial to detect early signs of relapse or transformation, which can occur in approximately 20% of patients within 5-10 years. The retroperitoneal location requires particular attention to abdominal imaging to monitor the primary disease site.
Additional Considerations
- The Follicular Lymphoma International Prognostic Index (FLIPI) should be determined in all patients to assess prognosis and guide treatment decisions 1
- Patients should be screened for main infectious diseases, including HIV and hepatitis B and C, prior to receiving cytotoxic and/or immunomodulatory drugs 1
- Molecular techniques, such as polymerase chain reaction for t(14;18) chromosomal translocation and/or for immunoglobulin gene rearrangement (Ig CDR3), are not recommended for routine assessment outside of clinical trials 1
From the FDA Drug Label
The main outcome measure of the study was progression-free survival (PFS) defined as the time from randomization to the first of progression, relapse, or death. The PFS results based on investigator assessment of progression were similar to those obtained by the independent review assessment. The main outcome measure of the study was progression-free survival (PFS), defined as the time from randomization in the maintenance/observation phase to progression, relapse, or death, as determined by independent review
- Progression-free survival (PFS) is used to monitor the patient's progress.
- The patient's progress is monitored by assessing the time from randomization to the first of progression, relapse, or death.
- Independent review assessment and investigator assessment of progression are used to determine PFS. 2
From the Research
Monitoring Patient Progress
The patient's progress with retroperitoneal non-Hodgkin's B cell stage 1 Follicular lymphoma can be monitored through various methods, including:
- Regular imaging tests such as magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography-computed tomography (PET-CT) to characterize and locate the tumor 3
- Endoscopic ultrasound fine needle aspiration (EUS-FNA) to provide pathological confirmation 3
- Monitoring of symptoms such as epigastric discomfort, nausea, and vomiting 3
- Laboratory tests to assess hemoglobin levels, serum LDH, and other factors that can affect prognosis 4
Prognostic Factors
The prognosis of follicular lymphoma can be affected by various factors, including:
- Age: patients over 60 years have a poorer prognosis 4
- Hemoglobin levels: patients with hemoglobin levels less than 12 g/dL have a poorer prognosis 4
- Serum LDH: patients with elevated serum LDH have a poorer prognosis 4
- Ann Arbor stage: patients with stage III/IV disease have a poorer prognosis 4
- Number of involved nodal areas: patients with more than 4 involved nodal areas have a poorer prognosis 4
Treatment and Follow-up
The treatment of follicular lymphoma depends on the stage and severity of the disease. Patients with early-stage disease may be treated with radiation therapy, while those with advanced disease may require chemotherapy, immunotherapy, or radioimmunotherapy 5. Regular follow-up appointments with a healthcare provider are necessary to monitor the patient's progress and adjust treatment as needed. The use of rituximab, a monoclonal antibody, has been shown to improve overall response rates, duration of response, and overall survival in patients with follicular lymphoma 4, 6.