Together, they emphasize that relapse evaluation must go beyond radiographic progression alone. Some patients may demonstrate disease progression on imaging but remain clinically stable enough for continued surveillance. Others develop symptomatic relapse, requiring prompt intervention. The faculty describe the importance of understanding disease tempo, symptom burden, and patient goals when determining whether and when to initiate second-line therapy as components of personalized care.

Assessing Relapse: Clinical, Biological, and Patient-Centered Considerations

The faculty address the pivotal question of how to evaluate patients who experience relapse. Dr. Mehta explains that the therapeutic landscape has expanded significantly compared with a decade ago, creating a need for more nuanced sequencing decisions. He reviews the growing number of FDA-approved options, including bispecific antibodies, CAR T-cell therapy, EZH2 inhibitors, and new combination regimens, and discusses how these advancements have reshaped treatment expectations.

A major focus of this segment is the concept of time to next treatment (TTNT), which Dr. Mehta identifies as one of the most meaningful clinical endpoints for patients. He outlines how TTNT can guide therapeutic choices and help clinicians weigh durability against toxicity and treatment burden. NP Bailey adds perspective on the importance of patient-related factors, including comorbidities, functional status, and lifestyle considerations that can influence therapy tolerability.

Videos

This segment outlines how clinicians today approach initial management, recognizing that improved survival and expanding treatment choices have dramatically changed the patient journey. As Mehta and Bailey note, frontline success does not eliminate the likelihood of relapse, making it essential to anticipate how early decisions may influence subsequent therapeutic sequencing. 

Evolving First-Line Standards and the Foundation of Follicular Lymphoma Care

In this opening segment, Dr. Amitkumar Mehta introduces the modern therapeutic framework for treating follicular lymphoma and outlines how first-line standards have evolved over the past decade. He reviews the conventional backbone of therapy, most commonly rituximab-based or bendamustine-rituximab regimens, and discusses how patient-specific factors, including tumor bulk, GELF criteria, comorbidities, and patient preferences, drive frontline decision-making. The conversation explores the principles behind watchful waiting, identifying which asymptomatic patients are candidates for initial observation and which require prompt treatment initiation.

Dr. Mehta and NP Lucy Bailey also emphasize how frontline responses influence expectations for long-term disease control in an indolent lymphoma that often follows a relapsing-remitting course. They highlight the importance of balancing disease management with quality of life, especially given the chronic nature of follicular lymphoma and the need to preserve future treatment options.

Lucy Bailey, CRNP

Articles

Assessing Relapse: Clinical, Biological, and Patient-Centered Considerations

Evolving First-Line Standards and the Foundation of Follicular Lymphoma Care