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Casadei et al. J Cancer Metastasis Treat 2022;8:21 Journal of Cancer
DOI: 10.20517/2394-4722.2022.05
Metastasis and Treatment

Review Open Access

Follicular lymphoma: the diminishing role of
chemotherapy

1,2
1,2
1,2
Beatrice Casadei , Laura Nanni , Ginevra Lolli , Pier Luigi Zinzani 1,2
1
IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, Bologna 40138, Italy.
2
Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna 40138, Italy.
Correspondence to: Pier Luigi Zinzani, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli"
and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna, Bologna 40138, Italy. E-mail:
pierluigi.zinzani@unibo.it
How to cite this article: Casadei B, Nanni L, Lolli G, Zinzani PL. Follicular lymphoma: the diminishing role of chemotherapy. J
Cancer Metastasis Treat 2022;8:21. https://dx.doi.org/10.20517/2394-4722.2022.05

Received: 10 Jan 2022 First Decision: 9 Feb 2022 Revised: 15 Apr 2022 Accepted: 10 May 2022 Published: 26 May 2022

Academic Editors: Lucio Miele, Francesca Montanari Copy Editor: Fangling Lan Production Editor: Fangling Lan

Abstract
Follicular lymphoma (FL) is the most common indolent non-Hodgkin lymphoma, accounting for 70% of cases in
Western countries. Despite this unique name, FL is an extremely heterogeneous disease, both clinically and
biologically. The basis of FL heterogeneity lies in the different biological pathways which can be activated, because
of the variety of gene mutations that can occur. Today, there is a growing interest in the knowledge of these
activated pathways, which is also testified by the presence of a new model that incorporates FL mutations to define
patient’s prognosis (m7-FLIPI). These evaluations are also appealing because of the recent possibility of using
“targeted therapies”. Targeted therapies are new tools, currently applicable in the setting of relapse/refractory
(R/R) disease, where we can find a great variety of “chemo-free” combinations. As in other hematologic
malignancies, “cellular therapy” enriches FL drug scenario, including T-cell dependent bispecific antibodies and
chimeric antigen receptor (CAR) T-cell. Since FL heterogeneity is the basis of the difference in therapeutic efficacy
and disease course among patients, the hope for the future is to understand FL biology more deeply, to better
comprehend how to obtain more representative samples and pre-treatment prognostic information in order to
individualize the treatment strategy as early as frontline therapy.
Keywords: Follicular lymphoma, POD24, target therapies, chemo-immunotherapy, biological heterogeneity

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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