Setting the Stage: Treatment Selection and Eligibility in Follicular Lymphoma

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?

Ryan Haumschild outlined the foundational approach to first-line follicular lymphoma treatment, noting that initial management begins with a thorough patient assessment before moving to anti-CD20-based chemoimmunotherapy regimens such as R-CHOP, R-CVP, or bendamustine-based combinations for patients with more progressive disease, with maintenance anti-CD20 therapy considered based on treatment goals, comorbidities, and patient fitness. He also highlighted the importance of identifying high-risk features early, particularly progression of disease within 24 months, known as POD24, which may signal transformation and warrant more aggressive evaluation and treatment escalation. Looking beyond frontline therapy, Ryan Haumschild described an increasingly rich landscape of later-line options, including R², CD19-targeted agents such as tafasitamab, bispecific CD3/CD20 agents such as epcoritamab, and cellular therapy, emphasizing that patient-specific factors including age, fitness, and organ involvement remain central to tailoring the most appropriate treatment approach.

Throughout the conversation, the experts provide a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward.

In the next episode, 'Operationalizing RRFL Care: Sequencing Therapies, Managing REMS, and the Role of R² in Practice,' Ryan Haumschild will continue his discussion on follicular lymphoma and highlight the operational and clinical considerations involved in managing a growing menu of relapsed or refractory treatment options, the infrastructure requirements for therapies ranging from R² to cellular therapy, and the practical strengths of lenalidomide plus rituximab as a cost-effective, broadly accessible regimen in the relapsed or refractory setting.