Answering questions in low-grade non-Hodgkin lymphoma

The ASH (American Society of Hematology) meeting in December is the largest gathering of lymphoma experts worldwide. In January, UK experts met in London to talk about the latest developments presented at ASH and their implications for clinical practice in the UK.

Over the coming weeks we will give you a detailed update from the ASH meeting. Here we talk about new drug developments for low-grade (slow-growing) non-Hodgkin lymphoma.

New drugs are always a focus of research, but maintenance and identifying the people likely to have worse outcomes were also key points of discussion about low-grade non-Hodgkin lymphoma.

Although most people with follicular lymphoma live for many years with a good quality of life, around 1 in 5 have lymphoma that progresses (gets worse) soon after treatment. There are already measures to help identify people at high risk of early progression, such as the follicular lymphoma international prognostic index (FLIPI), but these could be improved. POD24 is a measure that is being increasingly used in clinical trials. POD24 is a measure of how many people’s lymphoma progresses within 24 months (2 years) of the start of treatment. In the long-term, researchers might be able to identify factors that are common to those people who progress early. These factors could be used to identify people at risk of early progression before their first treatment and to find out if certain treatments can control their lymphoma for longer.

Maintenance treatment to keep lymphoma under control after successful first treatment keeps both follicular lymphoma and mantle cell lymphoma (MCL) under control for longer. People who had maintenance for mantle cell lymphoma also lived longer than those who were observed after treatment instead – the MCL Elderly trial showed that around 8 in 10 older people (60 or over) who had maintenance were still alive 5 years after treatment, compared with around 6 in 10 who did not.

For follicular lymphoma, having maintenance doesn’t increase the time you might live but it does extend remissions (time where the lymphoma is under control).

Ibrutinib is being recommended on the NHS for people with relapsed or refractory mantle cell lymphoma. However, it can only be used for people who have had only one previous course of treatment. The benefits of ibrutinib are much greater when it is used early for people with mantle cell lymphoma. 

Newer drugs are always of interest for improving treatment outcomes. Some trials test whether adding newer drugs to standard treatments can improve outcomes for people with low-grade NHL. Trials adding drugs that work by affecting the immune system, such as atezolizumab or lenalidomide, showed that caution should be used. Many lymphoma treatments cause immune system cells to be destroyed, so adding new drugs that affect the immune system can increase serious side effects like infection. The results of these trials are important in guiding the next steps in testing how these drugs could be used safely.

To read more news stories about clinical trials and to find a trial that might be suitable for you, visit Lymphoma TrialsLink.

With thanks to Dr Robert Marcus, Consultant Haematologist, for reviewing this article. 

Coming soon: The next update from this important meeting will cover maintenance for follicular lymphoma.