Understanding Relapsed/Refractory Follicular Lymphoma - Episode 1

Follicular Lymphoma Risk Factors, Diagnosis, Prognosis

Ajay Gopal, MD, Seattle Cancer Care Alliance

Ajay Gopal, MD: I'll start by talking a little bit about follicular lymphoma in general. When I meet someone who's been recently diagnosed with follicular lymphoma, I explain to them that this is the most common type of indolent lymphoma. This is a lymphoma that tends to grow slowly. Oftentimes, they are diagnosed just with incidental findings of some lumps that might've been palpable, that they could feel, sometimes in the neck or armpit or groin that have been there for a long time.

And they might start to grow slowly, and a biopsy happens. Under the microscope, we see that it's this cancer of white blood cells, typically a slow-growing cancer known as follicular lymphoma. The diagnosis is made by a hematopathologist, a specialized pathologist who can make these diagnoses of blood cancers.

Follicular lymphoma is usually diagnosed with a biopsy. Usually it's a biopsy of the lymph node that might be enlarged and as mentioned, made by an expert pathologist in the area because lymphomas are quite complicated, actually. And it's important to make sure that not only you make the right diagnosis of lymphoma but the right subtype because the treatment is quite different. When I meet someone who's newly diagnosed, we talk about something called staging, which is how we sort out where the lymphoma is located.

Is it causing any problems? That often will include imaging such as a CT [computed tomography] scan or a PET [positron emission tomography]/CT scan. Typically, laboratory tests will be done to make sure there's no impact on organ function or blood counts. And then I'll obviously examine and talk to my patients and try to understand, is there any impact to their quality of life that we might be able to blame on this follicular lymphoma? We put all that information together and we put together then a treatment plan, which might even be observation if there are really no problems that are being caused.

One big question, one common question is, what is the impact of this diagnosis going to be on my life, not only quality of life but also longevity? And I think now that we know a lot more about the biology of follicular lymphoma and we have many more treatments available if they're needed, and we'll talk a little bit more about those later, we understand that the vast majority of those diagnosed with follicular lymphoma should have a normal lifespan.

That's really gratifying, and I think it’s a comforting statement that I can make to my patients, which is different than I was saying say 10 years ago. Most patients will be expected to have a normal lifespan. And with that in mind, we try to make sure that we maintain quality of life, so that's a major goal. Strictly in terms of prognosis, there is something called the Follicular Lymphoma International Prognostic Index.

That's the most commonly quoted one, and that's how we can prognosticate. But it's important to keep in mind that these data are based on patients who were diagnosed decades ago. Treatment now and approaches now are quite different. There are some other prognostic scales that give similar information as well.

Transcript Edited for Clarity