Considerations in untreated patients

• For indolent lymphomas, the traditional goal of therapy has been to treat only when patients develop symptoms¹³
  • For patients with early-stage disease, especially in asymptomatic patients with low tumor burden, a watch-and-wait approach is often recommended²⁷
  • Treatment is usually initiated in patients with symptomatic disease, bulky lymphadenopathy or splenomegaly, or both, risk of local compressive disease, marrow compromise, or rapid disease progression¹³
• The timing and administration of therapy initiation and if these choices impact survival remain controversial⁸
  • The Groupe d'Etudes des Lymphomes Folliculaires (GELF) criteria are a set of guidelines to help physicians determine when to initiate treatment²⁸ (Table 9)
    • GELF criteria have been defined as parameters to initiate treatment in patients with untreated follicular lymphoma grade 1, 2, or 3A; having just 1 of the criteria justifies treatment²⁸

Table 9. GELF criteria: A guide for the need for treatment of indolent lymphoma.^28,29

• Ideally, selection of treatment should be highly individualized according to a patient's age, extent of disease, comorbidities, and treatment goals⁵
• The choice of first-line therapy for an incurable disease such as fNHL should consider not only response rates and time to progression, but also symptom control, potential impact on future therapies, including transplantation, and risk of secondary malignancies^3,30

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