Prognostic factors and the clinical course of follicular lymphoma in the FDG-PET and rituximab era.

Abstract

Follicular lymphoma (FL) is classically described as an incurable disease characterised by a distinctive clinical course, with repeated relapses and remissions. A progressive shortening of the duration of each remission and an increased relapse rate after each response is typically described. Major recent developments in the management of patients with FL have been the introduction of haematopoietic stem cell transplant (HSCT) and of rituximab treatment, resulting in a significant improvement in the overall survival of patients diagnosed with FL in the recent era. Another major advance in the 21st century is the introduction of 18-fluoro-deoxyglucose positron emission tomography (FDG-PET) for the staging of patients with lymphoma, which has proven to be more accurate than standard computer tomography. A new prognostic score, the Follicular Lymphoma International Prognostic Index 2 (FLIPI2) has been designed in the setting of these innovations. The aim of this thesis is to examine how the introduction of such advances has impacted on the management and on the clinical course of patients with FL. It will specifically address the impact that FDG-PET has on the staging, management and prognosis of FL and it will compare the recently designed FLIPI2 in newly diagnosed FL patients with the pre-rituximab prognostic score (FLIPI). As mentioned, the introduction of rituximab and HSCT has contributed to the significant improvement in the outcome of patients with FL. This thesis will demonstrate how these developments have changed not only the outcome but also the clinical course of patients with FL and will assess the impact that prior treatment with rituximab has on the outcome of patients undergoing a HSCT.