Clonal Evolution in Follicular Lymphoma

Summary

Participation Requirements

Description

Background: Follicular lymphoma (FL) is the second most common form of non-Hodgkin lymphoma and is incurable with standard first-line systemic therapy The clinical course of FL varies from slowly progressive over many years to a more rapid disease course that requires therapy shortly after diagnosis...

Background: Follicular lymphoma (FL) is the second most common form of non-Hodgkin lymphoma and is incurable with standard first-line systemic therapy The clinical course of FL varies from slowly progressive over many years to a more rapid disease course that requires therapy shortly after diagnosis Early initiation of therapy does not improve survival, and asymptomatic patients are often managed with an initial period of watchful waiting Clinical prognostic indices predict survival, but cannot predict outcome for individual patients; biologic-based classifiers (gene-expression profiling and somatic mutational analyses) are more robust than clinical indices, but require prospective clinical validation from the time of diagnosis in the modern treatment era Paired samples linked to clinical information can lead to the discovery and/or validation of therapeutic targets for FL patients at the highest risk of early disease progression Objective: Characterize the molecular biology and clinical course of FL patients, and evaluate the time to treatment initiation for those patients who require first-line systemic therapy Eligibility: Follicular lymphoma (grade 1-2, 3a) with no evidence of histological transformation No previous cytotoxic, biologic or monoclonal antibody therapy for FL (previous radiation therapy permitted) Age greater than or equal to 18 years ECOG performance status of 0-2 Design: Patients with FL who meet all eligibility criteria will enroll on the study for expert monitoring of their disease, improved risk-stratification, and donation of tissue and cellular products for research. Patients will be monitored prospectively until they require second-line systemic treatment or the patient decides to withdraw from the study; untreated patients will be followed with clinic visits every 4 months for the first 2 years. After 2 years, protocol-specified visits will be increased to every 6 months until 5 years. After 5 years, protocol-specified visits will be annually until disease progression requiring first-line therapy. Patients without an indication for first-line systemic therapy at 2 years from initial study enrollment will be offered an optional biopsy of their lymph node and bone marrow. During first-line systemic therapy, patients can continue being monitored on this study for post-therapy clonal evolution. Protocol-specified visits after therapy will be every 6 months until 3 years. After 3 years, protocol-specified visits will be annually until disease progression requiring second-line therapy. Upon initiation of second-line therapy, if applicable, patients will move to survival follow-up only.

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