Therapie des follikulären Lymphoms
Operation
Radiatio
Stadium I–II: Ergebnisse mit alleiniger Strahlentherapie. EFI: Extended-field-Bestrahlung; IFI: Involved-field-Bestrahlung; NS: nicht angegeben; OS: Gesamtüberleben; PFS: progressionsfreies Überleben; STLI: subtotale lymphatische Bestrahlung; TCLI: totale zentrale lymphatische Bestrahlung; TLI: totale lymphatische Bestrahlung; TNI: totale nodale Bestrahlung.
| Autor | Jahr | Patienten | ZV | Dosis | Follow-up | 5a-PFS | 10s-PFS | 15a-PFS | 5a-OS | 10a-OS | 15a-OS |
| Paryani | 1983 [38] | 124 | IFI/EFI/TLI | - | 5.5 | 62 | 54 | 42 | 84 | 68 | 40 |
| Gospodarowicz | 1984 [11] | 190 | IFI/EFI | 20–40 | 12 | 56 | 53 | – | 73 | 58 | - |
| McLaughlin | 1986 [30] | 50 | IF/EFI | 30–40 | 4 | 37 | – | – | 73 | – | – |
| Epelbaum | 1992 [8] | 48 | IFI/EFI | 30–50 | 6.3 | 71 | 57 | – | 83 | 68 | – |
| Vaughan Hudson | 1994 [56] | 149 | NS. | 35 | 10 | – | 47 | – | – | 64 | – |
| Pendlebury | 1995[40] | 58 | IFI/EFI | 40 (30–54) | NS. | 59 | 43 | – | 93 | 79 | – |
| MacManus | 1996 [28] | 177 | IFI/EFI/STLI/ TLI | 35–50 | 7.7 | 55 | 44 | 40 | 82 | 64 | 44 |
| Stuschke | 1997 [51] | 117 | EFI/TCLI | 26 + 10 | 5.7 | 71 | 59 (8a) | – | 86 | 86 (8a) | – |
| Gospodarowicz | 1999 [12] | 595 | IFI | 35 | 10.6 | 56 | 41 | – | 81 | 66 | – |
| Kamath | 1999 [22] | 72 | IFI/EFI/TLI | NS | NS | 62 | 59 | 47 | 73 | 46 | 40 |
| Voss | 2001 [58] | 228 | IFI | 30–35 | NS | 94 | 82 | 75 | 87 | 62 | 52 |
| Wilder | 2001 [59] | 80 | IFI/EFI | 40 (26–50) | 19 | 63 | 57 | 41 | 82 | 65 | 43 |
| Ott | 2003 [37] | 58 | IFI/EFI/TNI/ TLI | 40 (26–50) | 8.8 | 74 | 64 | – | 86 | 69 | – |
| Neumann | 2003 [33] | 116 | IFI/EFI/TNI | 35 (20–50) | 4 | 62 | 48 | – | 76 | 51 | – |
| Petersen | 2004 [41] | 460 | IFI | 35 (16– 47.5) | 12.5 | 56 | 41 | – | 79 | 62 | – |
| Guadagnolo | 2006 [14] | 79 | IFI/EFI | 36.7 (30–42) | 19 | – | 47 | 43 | – | 74 | 62 |
| Eich | 2009 [5] | 65 | IFI/EFI/TNI/ TLI | 40 (26–46) | 9.1 | 55 | 37 | – | 86 | 55 | – |
Z.T. Einschluss von limited stage III
Wait & Watch
GELF
- LK >7cm
- 3 Knoten in verschiedenen Arealen >3cm
- Symptomatisch
- Pruritus
- Milz > 16cm (CT)
- Organkompression
- Aszites, Pleuraerguss
- Serum-LDH oder B2MG erhöht
- HB < 10g/dl
- Neutrophie < 1500 µl
- Thrombos < 100.000/µl
systemische Therapie
Hochdosis-Chemotherapie
Obinutuzumab
Copanlisib
Lisocabtagen maraleucel, Breyanci®
FL3B, follikuläres Lymphom Grad 3B
rezidiviert oder
refraktär
nach >1 Vorbehandlungen
Erwachsene
RIT
Quellen
Nodal Follicular Lymphoma. The Role of Radiotherapy for Stages I and II.
Strahlenther Onkol 186(2010):191–6
2.) Jacobs JP, et al.:
Central lymphatic irradiation for stage III nodular malignant lymphoma: long term results.
JCO 11(1993):233–8.
3.) Wilder RB, et al.:
Long term results with radiotherapy for stage I–II follicular lymphomas.
IJROBP 51(2001):1219–27.
5.) Eich HT, Heimann M, Stutzer H, et al.:
Long-term outcome and prognostic factors in early-stage nodal low-grade non-Hodgkin’s lymphomas treated with radiation therapy.
Strahlenther Onkol 2009;185:288–95.
6.) Eich HT, Muller RP.:
Current role and future developments of radiotherapy in early-stage favourable Hodgkin’s lymphoma.
Strahlenther Onkol 2007;183:16–8.
7.) Eich HT, Muller RP, Engenhart-Cabillic R, et al.:
Involved-node radiotherapy in early-stage Hodgkin’s lymphoma. Definition and guidelines of the German Hodgkin Study Group (GHSG).
Strahlenther Onkol 2008;184: 406–10.
8.) Epelbaum R, Kuten A, Coachman NM, et al.:
Stage I–II low grade non-Hodgkin’s lymphoma: prognostic factors and treatment results.
Strahlenther Onkol 1992;168:66–72.
9.) Fuks Z, Kaplan HS.:
Recurrence rates following radiation therapy of nodular and diffuse malignant lymphomas.
Radiology 1973;108:675–84.
10). Glatstein E, Fuks Z, Goffinet DR, et al.:
Non-Hodgkin’s lymphomas of stage III extent. Is total lymphoid irradiation appropriate treatment?
Cancer 1976;37:2806–12.
11.) Gospodarowicz MK, Bush RS, Brown TC, et al.:
Prognostic factors in nodular lymphomas: a multivariate analysis based on the Princess Margaret Hospital experience.
Int J Radiat Oncol Biol Phys 1984;10:489–97.
12.) Gospodarowicz MK, Lippuner T, Pintilie M, et al.:
Stage I and II follicular lymphoma: longterm outcome and pattern of failure following treatment with involved field radiation therapy alone.
Int J Radiat Oncol Biol Phys 1999;45 (Suppl):217:abstract 137.
13.) Grulich AE, Vajdic CM.:
The epidemiology of non-Hodgkin lymphoma.
Pathology 2005;37:409–19.
14.) Guadagnolo BA, Li S, Neuberg D, et al.:
Long-term outcome and mortality trends in early-stage, grade 1–2 follicular lymphoma treated with radiation therapy.
Int J Radiat Oncol Biol Phys 2006;64:928–34.
15.) Ha CS, Cabanillas F, Lee MS, et al.:
Serial determination of the bcl-2 gene in the bone marrow and peripheral blood after central lymphatic irradiation for stages I–III follicular lymphoma: a preliminary report.
Clin Cancer Res 1997;3:215–9.
16.) Ha CS, Cabanillas F, Lee MS, et al.:
A prospective randomized study to compare the molecular response rates between central lymphatic irradiation and intensive alternating triple chemotherapy in the treatment of stage I–III follicular lymphoma.
Int J Radiat Oncol Biol Phys 2005;63: 188–93.
17.) Ha CS, Kong JS, McLaughlin P, et al.:
Stage III follicular lymphoma: long-term follow-up and patterns of failure.
Int J Radiat Oncol Biol Phys 2003;57:748–54.
18.) Harris NL, Jaffe ES, Diebold J, et al.:
World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues: report of the Clinical Advisory Committee Meeting, Airlie House, Virginia, November 1997.
J Clin Oncol 1999;17:3835–49.
19.) Herold M, Haas A, Srock S, et al.:
Rituximab added to first-line mitoxantrone, chlorambucil, and prednisolone chemotherapy followed by interferon maintenance prolongs survival in patients with advanced follicular lymphoma: an East German Study Group Hematology and Oncology Study.
J Clin Oncol 2007;25:1986–92.
20.) Hiddemann W, Kneba M, Dreyling M, et al.:
Frontline therapy with rituximab added to the combination of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) significantly improves the outcome for patients with advanced-stage follicular lymphoma compared with therapy with CHOP alone: results of a prospective randomized study of the German Low-Grade Lymphoma Study Group.
Blood 2005;106:3725–32.
21.) Jacobs JP, Murray KJ, Schultz CJ, et al.:
Central lymphatic irradiation for stage III nodular malignant lymphoma: long-term results.
J Clin Oncol 1993;11:233–8.
22.) Kamath SS, Marcus RB Jr, Lynch JW, et al.:
The impact of radiotherapy dose and other treatment-related and clinical factors on in-field control in stage I and II non-Hodgkin’s lymphoma.
Int J Radiat Oncol Biol Phys 1999;44:563–8.
23.) Kaminski MS, Tuck M, Estes J, et al.:
131I-tositumomab therapy as initial treatment for follicular lymphoma.
N Engl J Med 2005;352:441–9.
24.) Kelsey SM, Newland AC, Hudson GV, et al.:
A British National Lymphoma Investigation randomised trial of single agent chlorambucil plus radiotherapy versus radiotherapy alone in low grade, localised non-Hodgkin’s lymphoma.
Med Oncol 1994;11:19–25.
25.) Ladetto M, Drandi D, Compagno M, et al.:
PCR-detectable nonneoplastic Bcl-2/IgH rearrangements are common in normal subjects and cancer patients at diagnosis but rare in subjects treated with chemotherapy.
J Clin Oncol 2003;21:1398–403.
26.) Landberg TG, Hakansson LG, Moller TR, et al.:
CVP-remission-maintenance in stage I or II non-Hodgkin’s lymphomas: preliminary results of a randomized study.
Cancer 1979;44:831–8.
27.) Lopez-Guillermo A, Cabanillas F, McLaughlin P, et al.:
The clinical significance of molecular response in indolent follicular lymphomas.
Blood 1998;91:2955–60.
28.) MacManus MP, Hoppe RT.:
Is radiotherapy curative for stage I and II low-grade follicular lymphoma? Results of a long-term follow-up study of patients treated at Stanford University.
J Clin Oncol 1996;14:1282–90.
29.) Marcus R, Imrie K, Belch A, et al.:
CVP chemotherapy plus rituximab compared with CVP as first-line treatment for advanced follicular lymphoma.
Blood 2005;105:1417–23.
30.) McLaughlin P, Fuller LM, Velasquez WS, et al.:
Stage I–II follicular lymphoma. Treatment results for 76 patients.
Cancer 1986;58:1596–602.
31.) Monfardini S, Banfi A, Bonadonna G, et al.:
Improved five year survival after combined radiotherapy-chemotherapy for stage I–II non-Hodgkin’s lymphoma.
Int J Radiat Oncol Biol Phys 1980;6:125–34.
32.) Murtha AD, Rupnow BA, Hansosn J, et al.:
Long-term follow-up of patients with stage III follicular lymphoma treated with primary radiotherapy at Stanford University. I
nt J Radiat Oncol Biol Phys 2001;49:3–15.
33.) Neumann H, Blanck H, Koch R, et al.:
[Follicle centre lymphoma: treatment results for stage I and II.]
Strahlenther Onkol 2003;179:840–6.
34.) Nissen NI, Ersboll J, Hansen HS, et al.:
A randomized study of radiotherapy versus radiotherapy plus chemotherapy in stage I–II non-Hodgkin’s lymphomas.
Cancer 1983;52:1–7.
35.) The Non-Hodgkin’s Lymphoma Classification Project.:
A clinical evaluation of the International Lymphoma Study Group classification of non-Hodgkin’s lymphoma.
Blood 1997;89:3909–18.
36.) Ott G, Katzenberger T, Lohr A, et al.:
Cytomorphologic, immunohistochemical, and cytogenetic profiles of follicular lymphoma: 2 types of follicular lymphoma grade 3.
Blood 2002;99:3806–12.
37.) Ott OJ, Rodel C, Gramatzki M, et al.:
Radiotherapy for stage I–III nodal low-grade non-Hodgkin’s lymphoma.
Strahlenther Onkol 2003;179:694–701.
38.) Paryani SB, Hoppe RT, Cox RS, et al.:
Analysis of non-Hodgkin’s lymphomas with nodular and favorable histologies, stages I and II.
Cancer 1983;52:2300–7.
39.) Paryani SB, Hoppe RT, Cox RS, et al.:
The role of radiation therapy in the management of stage III follicular lymphomas.
J Clin Oncol 1984;2:841–8.
40.) Pendlebury S, el Awadi M, Ashley S, et al.:
Radiotherapy results in early stage low grade nodal non-Hodgkin’s lymphoma.
Radiother Oncol 1995;36: 167–71.
41.) Petersen PM, Gospodarowicz M, Tsang R, et al.:
Long-term outcome in stage I and II follicular lymphoma following treatment with involved field radiation therapy alone.
J Clin Oncol 2004;22:Suppl 14:abstract 6521.
42.) Press OW, Unger JM, Braziel RM, et al.:
Phase II trial of CHOP chemotherapy followed by tositumomab/iodine I-131 tositumomab for previously untreated follicular non-Hodgkin’s lymphoma: five-year follow-up of Southwest Oncology Group Protocol S9911.
J Clin Oncol 2006;24:4143–9.
43.) Pulsoni A, Starza ID, Frattarelli N, et al.:
Stage I/II follicular lymphoma: spread of bcl-2/IgH+ cells in blood and bone marrow from primary site of disease and possibility of clearance after involved field radiotherapy.
Br J Haematol 2007;137:216–20.
44.) Richaud PM, Soubeyran P, Eghbali H, et al.:
Place of low-dose total body irradiation in the treatment of localized follicular non-Hodgkin’s lymphoma: results of a pilot study.
Int J Radiat Oncol Biol Phys 1998;40:387–90.
45.) Rochet N, Sterzing F, Jensen A, et al.:
Helical tomotherapy as a new treatment technique for whole abdominal irradiation.
Strahlenther Onkol 2008;184:145–9.
46.) Salles G, Mounier N, de Guibert S, et al.:
Rituximab combined with chemotherapy and interferon in follicular lymphoma patients: results of the GELA-GOELAMS FL2000 study.
Blood 2008;112:4824–31.
47.) Seymour JF, Pro B, Fuller LM, et al.:
Long-term follow-up of a prospective study of combined modality therapy for stage I–II indolent non-Hodgkin’s lymphoma.
J Clin Oncol 2003;21:2115–22.
48.) Specht L.:
Primary radiotherapy of localised indolent non-Hodgkin’s lymphoma.
Radiother Oncol 2002;64(Suppl 1):abstract 7a.
49.) Sterzing F, Schubert K, Sroka-Perez G, et al.:
Helical tomotherapy. Experiences of the first 150 patients in Heidelberg.
Strahlenther Onkol 2008;184:8–14.
50.) Studer G, Luetolf UM, Glanzmann C.:
Locoregional failure analysis in head-and-neck cancer patients treated with IMRT.
Strahlenther Onkol 2007;183:417–23, discussion 424–5.
51.) Stuschke M, Hoederath A, Sack H, et al.:
Extended field and total central lymphatic radiotherapy in the treatment of early stage lymph node centroblastic-centrocytic lymphomas: results of a prospective multicenter study. Study Group NHL-frühe Stadien.
Cancer 1997;80:2273–84.
52.) Sutcliffe SB, Gospodarowicz MK, Bush RS, et al.:
Role of radiation therapy in localized non-Hodgkin’s lymphoma.
Radiother Oncol 1985;4:211–23.
53.) Tsang RW, Gospodarowicz MK.:
Low-grade non-Hodgkin lymphomas.
Semin Radiat Oncol 2007;17:198–205.
54.) Tsang RW, Gospodarowicz MK. Non-Hodgkin’s lymphoma. In: Gunderson LL, Tepper JE, eds.:
Clinical radiation oncology.
Philadelphia: Elsevier Churchill Livingstone, 2007:1713–51. 55.) Tsang RW, Gospodarowicz MK, O’Sullivan B.:
Staging and management of localized non-Hodgkin’s lymphomas: variations among experts in radiation oncology.
Int J Radiat Oncol Biol Phys 2002;52:643–51.
56.) Vaughan Hudson B, Vaughan Hudson G, MacLennan KA, et al.:
Clinical stage 1 non-Hodgkin’s lymphoma: long-term follow-up of patients treated by the British National Lymphoma Investigation with radiotherapy alone as initial therapy.
Br J Cancer 1994;69:1088–93.
57.) Kuruvilla J, Assouline S, Hodgson D, et al.:
A Canadian Evidence-Based Guideline for the First-Line Treatment of Follicular Lymphoma: Joint Consensus of the Lymphoma Canada Scientific Advisory Board.
Clinical Lymphoma Myeloma and Leukemia 2015; 15:59-74
