What are the second-line treatment options for follicular lymphoma (FL)?

Updated: Jan 16, 2019
  • Author: Francisco J Hernandez-Ilizaliturri, MD; Chief Editor: Koyamangalath Krishnan, MD, FRCP, FACP  more...
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Answer

Answer

Treatment options include the following:

  • Rituximab 375 mg/m 2 IV weekly for 4wk
  • Any rituximab chemotherapy regimen described in the first-line treatment setting that was not used before
  • Idelalisib 150 mg PO BID is a phosphoinositide 3-kinase (PI3K) delta inhibitor that has been granted accelerated approval by the US Food and Drug Administration (FDA) (ie, confirmatory clinical trials in progress) for relapsed FL in patients who have received at least two prior systemic therapies [14]
  • Copanlisib 60 mg IV on days 1, 8, and 15 of a 28-day treatment cycle on an intermittent schedule (21 days on and 7 days off). Continue treatment until disease progression or unacceptable toxicity. Copanlisib is another PI3K delta inhibitor granted accelerated approval by the FDA for relapsed FL in patients who have received at least two prior systemic therapies. [15]
  • Radioimmunotherapy (only if adequate bone marrow function, < 25% bone marrow involvement by lymphoma, and nonbulky adenopathy)
  • Consider high-dose chemotherapy and autologous SCT if third relapse
  • Consider allogeneic BMT if the duration of response after first-line therapy was < 1 y

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