Welcome back to another AJMC Insights series. In this episode titled, 'Setting the Stage: Treatment Selection and Eligibility in Follicular Lymphoma,' Ryan Haumschild, PharmD, MS, MBA, CPEL led the conversation about the following questions: 1. What are the first-line treatment options in follicular lymphoma? 2. When are you considering a patient eligible for later lines of therapy?
In this episode, 'Operationalizing RRFL Care: Sequencing Therapies, Managing REMS, and the Role of R² in Practice,' the pharmacist Ryan Haumschild, PharmD, MS, MBA, CPEL explores the following questions: 1. From a pharmacy operations standpoint, how do you characterize the current treatment landscape for relapsed or refractory follicular lymphoma (RRFL), and how has the growing number of available agents affected formulary management and operational planning at your institution? 2. Lenalidomide plus rituximab has been a commonly used combination in RRFL. How have you positioned this regimen in your own practice, and what have been its strengths and limitations in your experience?
In 'From Data to Practice: Interpreting inMIND Trial Results and the Role of Tafasitamab in RRFL,' Ryan Haumschild, PharmD, MS, MBA, CPEL delves into the following critical questions
This episode, titled 'What It Takes to Make the Pathway: Clinical and Operational Criteria for Adding New Combinations in RRFL,' features Ryan Haumschild, PharmD, MS, MBA, CPEL discussing the following critical question:
In this episode, 'Epcoritamab in RRFL: Efficacy Data, Administration Considerations, and the Pharmacist's Operational Role,' Ryan Haumschild, PharmD, MS, MBA, CPEL explores the following questions:
In 'From Promise to Practice: Overcoming Access and Administration Challenges for Bispecifics in RRFL,' Ryan Haumschild, PharmD, MS, MBA, CPEL delves into the following critical question:
This episode, titled 'NCCN Guidelines in Focus: Key Updates for Follicular Lymphoma and Their Impact on Formulary Decisions,' features Ryan Haumschild, PharmD, MS, MBA, CPEL discussing the following critical questions:
In this episode, 'Streamlining Prior Authorization: Strategies for Securing Timely Access to New RRFL Regimens,' Ryan Haumschild, PharmD, MS, MBA, CPEL explores the following question:
Christina Poh discussed how she counsels patients on follicular lymphoma as a chronic, relapsing-remitting disease that is highly treatable, with many patients living for years or even decades with good quality of life, while being transparent that current standard-of-care treatments are unlikely to be curative, framing this honest, forward-looking conversation as the foundation for a long-term therapeutic partnership built on realistic expectations and shared planning.
Christina Poh confirmed that the disconnect between provider and patient experiences of shared decision-making resonates strongly with what she observes in clinical practice, noting that while care teams tend to focus on efficacy and side effect profiles, the questions patients ask most frequently are logistical in nature, underscoring that closing this gap requires not only better communication, but also more robust patient navigation support, improved coordination between academic and community settings, and clinical trial designs that better reflect the real-world follicular lymphoma patient population.
Christina Poh reviewed the inMIND safety data, noting that the addition of tafasitamab to the lenalidomide and rituximab backbone produced a manageable safety profile that was generally consistent with the R² backbone alone with no major unexpected safety signals observed and overall good patient tolerability throughout the trial.
Christina Poh examined the highly individualized nature of the rituximab versus obinutuzumab decision in follicular lymphoma, framing it as a patient-specific assessment that must weigh efficacy advantages against a meaningfully higher tolerability burden that may not be appropriate for all patients.
Christina Poh discussed how the trial data reporting a PFS benefit of 88.9% versus 66.7% at 5 years and an OS advantage for IFRT plus rituximab maintenance in stage III follicular lymphoma does not entirely overturn the conventional view of radiation as a primarily early-stage tool, but does meaningfully challenge the assumption that radiotherapy has no role in advanced-stage disease while noting that additional studies are needed to confirm these findings and to evaluate radiation's role in combination with systemic therapies beyond rituximab.
Christina Poh described the early phase efficacy data for golcadomide as highly impressive, noting that the high overall response rates and durability of responses a very promising signal that she expects will translate into a meaningful role for this first-in-class oral CELMoD agent in the relapsed or refractory follicular lymphoma treatment landscape in the near future.
Christina Poh described the real-world data from eight CUBIC centers as highly encouraging, interpreting response rates that match or exceed those seen in pivotal trials in a heavily pretreated and older patient population as confirmation that bispecific antibodies are a broadly active and impressive class of treatment that already plays an important role in relapsed or refractory follicular lymphoma.
Led by the moderator, Christina Poh shared her closing reflections on the relapsed or refractory follicular lymphoma treatment landscape, expressing strong optimism about both the current state and near-term future of the field, noting that the development of many novel, highly effective treatment options over the past several years has fundamentally transformed what is possible for patients with this chronic, relapsing disease.
Tara Graff noted that while RRFL patients themselves do not look fundamentally different between community and academic settings, what varies is how those patients are managed at relapse, with disease trajectory serving as one of the most critical and sometimes underappreciated factors in community practice treatment decision-making.
Tara Graff described her approach to communicating PFS data with patients, explaining that rather than using clinical terminology, she frames progression-free survival in terms patients can connect with, presenting treatment options side by side and translating trial outcomes into plain language estimates of how long a given therapy is likely to keep their disease in remission.
Tara Graff examined the evolution of R² in community oncology practice, reflecting on how the combination represented a genuine game changer when it emerged in the second-line follicular lymphoma setting approximately, offering patients a chemo-free option with meaningful improvements in PFS and time to next therapy that distinguished it from simply retreating patients with rituximab monotherapy.
Tara Graff discussed how the introduction of tafasitamab into the R² backbone represents a natural next step for community oncologists who have already become comfortable with both components of the regimen, noting that many community practices gained experience with tafasitamab in the diffuse large B-cell lymphoma setting, meaning that adding it to a now-familiar R² backbone does not require learning an entirely new drug, but rather learning a new pairing with a well-understood side effect profile.
Tara Graff discussed her experience with epcoritamab-based combinations in follicular lymphoma, noting that her practice's participation in both epcoritamab monotherapy and combination therapy trials has provided her with firsthand familiarity with the regimen and that the efficacy data, particularly the overall response and complete response rates associated with epcoritamab plus R², is compelling.
Tara Graff highlighted the significance of 2025 as a landmark year for RRFL treatment, with the June 2025 approval of tafasitamab plus R² and the November 2025 approval of epcoritamab plus R² representing two major additions to the NCCN guidelines that meaningfully expand the second-line treatment options available to follicular lymphoma patients beyond the R² backbone and signaling a clear directional shift toward novel, non-chemotherapy combinations that can deliver progression-free survival measured in years.
Tara Graff outlined a practical framework for community oncology practices looking to establish safe and successful programs with novel regimens, emphasizing that while tafasitamab-based combinations can be adopted with relatively minimal operational changes, bispecific antibodies require more deliberate infrastructure investment, but that every community site has the capacity to build this capability with the right approach.
