For the majority of patients with newly diagnosed follicular lymphoma (FL), current treatments, while not curative, allow for long remission durations. However, several important needs remain unaddressed. Studies have consistently shown that ∼20% of patients with FL experience disease progression within 2 years of first-line treatment, and consequently have a 50% risk of death in 5 years. Better characterization of this group of patients at diagnosis may provide insight into those in need of alternate or intensive therapies, facilitate a precision approach to inform clinical trials, and allow for improved patient counseling. Prognostic methods to date have employed clinical parameters, genomic methods, and a wide assortment of biological and biochemical markers, but none so far has been able to adequately identify this high-risk population. Advances in the first-line treatment of FL with chemoimmunotherapy have led to a median progression-free survival (PFS) of approximately 7 years; creating a challenge in the development of clinical trials where PFS is a primary end point. A surrogate end point that accurately predicts PFS would allow for new treatments to reach patients with FL sooner, or lessen toxicity, time, and expense to those patients requiring little to no therapy. Quality of response to treatment may predict PFS and overall survival in FL; as such complete response rates, either alone or in conjunction with PET imaging or minimal residual disease negativity, are being studied as surrogates, with complete response at 30 months after induction providing the strongest surrogacy evidence to date. A better understanding of how to optimize quality of life in the context of this chronic illness is another important focus deserving of further study. Ongoing efforts to address these important unmet needs are herein discussed.

中文翻译：

---

一线治疗滤泡性淋巴瘤的需求未得到满足

对于大多数新诊断为滤泡性淋巴瘤（FL）的患者，目前的治疗虽然不能治愈，但可以延长缓解时间。但是，一些重要的需求仍未解决。研究一致表明，约有20％的FL患者在一线治疗后2年内经历疾病进展，因此5年内有50％的死亡风险。在诊断时更好地表征这组患者可以提供对需要替代治疗或强化治疗的患者的了解，有助于为临床试验提供精确的方法，并可以改善患者咨询服务。迄今为止的预后方法已经采用了临床参数，基因组方法以及各种各样的生物学和生化标志物，但到目前为止，尚无一种方法能够充分识别这种高危人群。化学免疫疗法治疗FL的一线治疗取得了进展，导致中位无进展生存期（PFS）约为7年；在以PFS为主要终点的临床试验的发展中提出了挑战。可以准确预测PFS的替代终点可以使新疗法更早地到达FL病人，或者减少对那些几乎不需要治疗的病人的毒性，时间和费用。对治疗的反应质量可以预测FL的PFS和整体生存率；因此，单独或结合PET成像或最小残留疾病阴性率的完全缓解率正在作为替代指标进行研究，诱导后30个月的完全缓解率是迄今为止最强的替代指标。对如何在这种慢性疾病中优化生活质量的更好理解是值得进一步研究的另一个重要重点。本文讨论了解决这些重要的未满足需求的持续努力。