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Aktuelle Therapiestrategien beim follikulären Lymphom

Current treatment strategies for follicular lymphoma

  • Schwerpunkt: Maligne Lymphome
  • Published:
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Zusammenfassung

In den letzten Jahren haben sich in der Behandlung follikulärer Lymphome wesentliche Fortschritte ergeben, die zu einer substanziellen Verbesserung der Prognose betroffener Patienten geführt haben. Bei Patienten in den begrenzten Stadien I und II kann eine Strahlentherapie zu dauerhaften Remissionen führen, wobei unklar bleibt, ob diese einer echten Heilung entsprechen. Neue Ansätze streben daher die Kombination der Strahlentherapie mit einem Anti-CD20-Antikörper an. Bei Patienten in den fortgeschrittenen Stadien III und IV, die eine niedrige Tumorlast haben, ist abwartendes Beobachten weiterhin das Vorgehen der ersten Wahl. Bei Patienten mit hoher Tumorlast ist eine Immunchemotherapie gefolgt von einer 2‑jährigen Erhaltungstherapie mit Rituximab der weltweit akzeptierte Standard. Mit neuen Antikörpern und Substanzen, die in onkogene Signalübertragungswege eingreifen oder immunmodulatorisch wirken, sind in den letzten Jahren hochattraktive neue Therapieoptionen entwickelt worden, die gegenwärtig in Phase-II/III-Studien erprobt werden. Diese Ansätze eröffnen die Perspektive, in der nahen Zukunft chemotherapiefreie Behandlungskonzepte zu etablieren.

Abstract

In the last few years major changes have taken place in the management of follicular lymphoma (FL) leading to a substantial improvement in the prognosis of patients suffering from this disease. For patients with limited disease stages I and II radiotherapy can lead to long-term remission, while it still remains unclear whether this actually represents a cure; therefore, new approaches are investigating the combination of irradiation with an anti-CD20 antibody. For patients with advanced stages III and IV and a low tumor burden, watch and wait is still the first choice of management. For advanced stages III and IV and a high tumor burden, immunochemotherapy followed by 2 years of rituximab maintenance therapy is the worldwide accepted standard. New antibodies and new agents targeting oncogenic pathways or having immunomodulatory activity provide attractive new therapeutic options, which are currently being explored in clinical phase II/III studies. These approaches provide the perspective to establish chemotherapy-free therapy concepts in the near future.

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Authors and Affiliations

  1. Klinikum der Universität München, Campus Großhadern, Medizinische Klinik und Poliklinik III, Marchioninistr. 15, 81377, München, Deutschland

    W. Hiddemann, E. Hoster, C. Schmidt, M. Dreyling & M. Unterhalt

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Correspondence to W. Hiddemann.

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Interessenkonflikt

W. Hiddemann gibt an, Beraterhonorare und Forschungsförderung von Roche und Janssen sowie Beraterhonorare von Janssen, Roche, Gilead und Celgene erhalten zu haben. M. Dreyling gibt an, Sprecher- und Beraterhonorare von Bayer, Celgene, Gilead, Janssen, Mundipharma, Pfizer und Roche sowie institutionelle Forschungsförderung von Celgene, Janssen, Mundipharma und Roche erhalten zu haben. M. Unterhalt gibt an, Unterstützung zur Teilnahme an wissenschaftlichen Kongressen von der Firma Roche erhalten zu haben. C. Schmidt gibt an, Förderung im Rahmen von Kongressunterstützungen der Firmen Janssen, Gilead und Takeda erhalten zu haben. E. Hoster gibt an, Reisekostenunterstützung von der Roche Pharma AG erhalten zu haben.

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Hiddemann, W., Hoster, E., Schmidt, C. et al. Aktuelle Therapiestrategien beim follikulären Lymphom. Internist 57, 222–229 (2016). https://doi.org/10.1007/s00108-015-0009-3

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  • DOI: https://doi.org/10.1007/s00108-015-0009-3

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