From September 6 to 8, 2024, the 5th Tianjin International Lymphoma Conference was grandly held, attracting global experts to foster academic exchange and cooperation. During the conference, Hematology Frontier invited Dr. Peiqi Zhao from Tianjin Medical University Cancer Institute and Hospital to discuss the latest advances in follicular lymphoma treatment and the evolving concept of comprehensive disease management.

Hematology Frontier: In recent years, new drugs have continuously been introduced for the treatment of follicular lymphoma. How would you assess the practical effects of these new drugs in treating follicular lymphoma? Are there any promising new drugs currently in development?

Dr. Peiqi Zhao: The pace of new drug development in the field of lymphoma is particularly rapid, making it one of the most active areas in oncology drug research. As a significant subset of lymphomas, follicular lymphoma has similarly witnessed remarkable therapeutic breakthroughs. In recent years, multiple new drugs have been approved for treating follicular lymphoma, significantly expanding treatment options.

Bruton’s tyrosine kinase (BTK) inhibitors, such as zanubrutinib, have been included in follicular lymphoma treatment guidelines based on the exceptional results from the ROSEWOOD study, marking another major milestone in precision-targeted therapy. Additionally, CAR-T cell therapy has shown extraordinary efficacy in follicular lymphoma, particularly in relapsed and refractory cases, as confirmed by the ZUMA-5 trial. This study demonstrated very high treatment response and complete remission rates (CRR), both exceeding 90%, offering unprecedented hope for patients. Moreover, bispecific antibodies, such as CD20/CD3, have made significant progress, with related drugs already approved abroad for treating relapsed and refractory follicular lymphoma. These drugs have shown a single-agent efficacy rate of up to 80% and a CR rate of 60%, and their efficacy is expected to improve further with combination therapy. Approval in China is also on the horizon.

In addition, BCL-2 inhibitors and PI3K inhibitors have emerged as innovative treatments for follicular lymphoma. These new therapies not only enrich treatment options but also provide more personalized and precise treatment plans for patients.

In summary, follicular lymphoma patients are entering a new era of drug development, with an array of novel therapies offering enhanced treatment potential.

Hematology Frontier: Follicular lymphoma patients exhibit considerable clinical variation, particularly high-risk patients. Could you share how to optimize treatment plans for high-risk patients in clinical practice? Are there new research findings or strategies that can improve their treatment outcomes?

Dr. Peiqi Zhao: Although follicular lymphoma patients generally have favorable prognoses, with a median survival time of approximately 18 years, it is important not to overlook the subgroup of patients with less favorable outcomes, such as those with POD24 or large tumors. This highlights the significant heterogeneity within follicular lymphoma.

For these high-risk groups, intensive research is being conducted. Under the leadership of Director Huilai Zhang, the Lymphoma Department of Tianjin Medical University Cancer Institute and Hospital has always been at the forefront of exploring follicular lymphoma. Earlier research has revealed encouraging results in treating patients with large tumors, particularly those with diameters exceeding 10 cm, using a sequential treatment of radiotherapy, followed by tislelizumab combined with R-CHOP. This success was presented at the 2023 ASH Annual Meeting, and to date, over ten patients have been included in the study, demonstrating not only significant efficacy but also good safety profiles.

Furthermore, treatment strategies for high-risk patients continue to expand. For instance, combining BTK inhibitors with other therapies shows potential, while bispecific antibodies are beginning to show promise in first-line treatments and early-stage second-line treatments for patients with early disease progression. These studies indicate that combining new drugs with traditional treatments can significantly improve outcomes for high-risk patients, providing them with greater survival benefits.

We look forward to these research findings being quickly translated into clinical practice, bringing substantial efficacy improvements and enhanced quality of life to follicular lymphoma patients, especially those with poor prognoses.

Hematology Frontier: Follicular lymphoma treatment usually requires long-term management. In clinical practice, how do you approach long-term monitoring and prognosis management for patients? Are there any new methods or strategies to help improve patient survival and long-term outcomes?

Dr. Peiqi Zhao: Given the extended survival of follicular lymphoma patients, long-term, systematic follow-up and monitoring are essential. This process should span pre-treatment assessment, ongoing monitoring during treatment, and, most importantly, continuous post-treatment follow-up. The Lymphoma Department at Tianjin Medical University Cancer Institute and Hospital, as one of the pioneers of the comprehensive disease management concept for lymphoma, has recently established a specialized outpatient clinic for follicular lymphoma. This clinic aims to provide a more specialized and personalized follow-up platform for patients, ensuring precise implementation and timely adjustments to treatment plans, while also strengthening ongoing disease monitoring and lifestyle guidance.

In our follow-up work with follicular lymphoma patients, we emphasize a multi-dimensional, comprehensive monitoring strategy. On one hand, we closely monitor patients’ disease status through physical exams, hematologic tests, and imaging studies, ensuring timely detection and intervention for potential relapse or progression. On the other hand, we focus on assessing patients’ quality of life, which is a crucial component of measuring treatment efficacy and prognosis. Clinicians should actively evaluate whether patients can recover and maintain a high quality of life post-treatment, ensuring they can effectively reintegrate into daily work and social activities, achieving holistic physical and mental recovery.

For many follicular lymphoma patients, achieving a high quality of life is one of the key treatment goals, and it is also a direction in which we, as doctors, strive. Through comprehensive disease management and the establishment of specialized outpatient services, we aim to provide patients with more comprehensive, meticulous, and personalized medical care, helping them achieve a brighter future in their fight against the disease.

Dr. Peiqi Zhao Ph.D. in Medicine, Associate Chief Physician Lymphoma Department, Tianjin Medical University Cancer Institute and Hospital Specializing in the diagnosis and treatment of lymphoma, as well as basic and clinical research in the field. He has led a National Natural Science Foundation project and participated in several national and provincial research projects. He has published over 20 SCI papers and contributed as a board member and expert writer for the CSCO and CACA lymphoma diagnosis and treatment guidelines. Positions held:

• Member of the Second Committee of the Chinese Medical Promotion Association’s Oncology Medicine Branch
• Member of the Lymphoma Committee of the Chinese Geriatrics Society
• Executive Committee Member of the Beijing Cancer Prevention Society’s Lymphoma Immunotherapy Committee
• Member of the Lymphoma Committee of the Tianjin Anti-Cancer Association
• Vice Chairman of the Youth Committee of the Lymphoma Committee of the Tianjin Anti-Cancer Association
• Member of the Clinical Chemotherapy Committee of the Tianjin Anti-Cancer Association
• Member of the Clinical Drug Research Committee of the Tianjin Anti-Cancer Association