From the Research
Blood vessel involvement in retroperitoneal B-cell follicular lymphoma is a concerning feature that may indicate more aggressive disease behavior and potential for wider dissemination of the disease through the vascular system. In follicular lymphoma, which typically follows an indolent course, blood vessel involvement suggests potential for more extensive disease spread. When lymphoma cells invade blood vessels, they can travel to distant sites, potentially leading to more extensive disease spread. This vascular invasion may be detected through imaging studies like contrast-enhanced CT or MRI, or definitively diagnosed through histopathological examination of tissue samples 1. The presence of blood vessel involvement may influence staging, prognosis, and treatment decisions, potentially warranting more aggressive therapeutic approaches. Treatment typically involves systemic therapy such as immunochemotherapy (R-CHOP or R-bendamustine), as localized approaches may be insufficient when vascular spread is present 2. Close monitoring with regular imaging and follow-up is essential to assess treatment response and detect any disease progression. Some key points to consider in the management of follicular lymphoma include:
- The Follicular Lymphoma International Prognostic Index (FLIPI) uses five independent predictors of inferior survival: age >60 years, hemoglobin <12 g/dL, serum LDH > normal, Ann Arbor stage III/IV, number of involved nodal areas >4 1.
- Modern therapies have demonstrably improved prognosis, with chemoimmunotherapy improving response rates, duration of response, and overall survival (OS) 3.
- Maintenance rituximab has shown additional benefit in randomized studies 1, 3.
- Lenalidomide was non-inferior to chemoimmunotherapy in a randomized front-line study and, when combined with rituximab, was superior to rituximab alone in relapsed FL 1, 3. Given the most recent and highest quality evidence, the use of immunochemotherapy such as R-CHOP or R-bendamustine, along with close monitoring and maintenance rituximab, is recommended for the treatment of follicular lymphoma with blood vessel involvement 2.