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EHA 2026 | Addressing unmet needs in follicular lymphoma across the treatment journey
Marco Ladetto, MD, Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy, explores the evolving challenges of managing follicular lymphoma in an era of expanding treatment options. He discusses key unmet needs across the disease course, including treatment selection, management of relapsed disease, sequencing of novel therapies, and care of elderly or frail patients. This interview took place at the 31st Congress of the European Hematology Association (EHA) in Stockholm, Sweden.
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Transcript
I gave the educational lecture on this topic, basically. Difficult for a patient is no longer, as in the past, the absence of treatment. Often the difficulty is to choose the appropriate treatment in a very broad and therapeutic armamentarium. We have now more treatments. All the treatment lines are changing very rapidly, and this is generating novel issues, novel unmet needs, and also generates a lack of knowledge on some issues...
I gave the educational lecture on this topic, basically. Difficult for a patient is no longer, as in the past, the absence of treatment. Often the difficulty is to choose the appropriate treatment in a very broad and therapeutic armamentarium. We have now more treatments. All the treatment lines are changing very rapidly, and this is generating novel issues, novel unmet needs, and also generates a lack of knowledge on some issues. So basically, I focus on all the different phases of follicular lymphoma treatment, which could be the difficult points, the choice of treat or not to treat a low-tumor burden patient, so the choice of active surveillance versus the choice of rituximab monotherapy. I discuss the first-line treatment with all the issues of potential toxicity and immunosuppression versus the risk associated with alternative treatments, the role of maintenance and how maintenance should be delivered. Then I discussed the first relapse with the issue that novel approaches such as R-TAF-R2 and R-EPCO-R2 are now basically wiping out the line from other treatments such as autologous transplantation. And, of course, they provide a better solution compared to the R-CHOP standard for a large proportion of patients, especially high-risk. I then discussed the third line, comparing CAR-T versus bispecific, and also discussed the issue of patients that fail either CAR-T or bispecific, how should we handle them, how should we treat them in a context where the available treatments are indeed many, but we don’t have accumulated enough knowledge specific to follicular lymphoma for this kind, for how to choose, how to define the strategy if you use bispecific first, or CAR-T first, or whatever. And also the potential use of new treatments coming into this field. Finally, I touched upon the issue of elderly frail patients that are, again, a population that is still not very well studied for follicular lymphoma that has a specific critical issue that needs to be addressed, but considering that this patient can also achieve excellent responses if you can provide an approach which is adequately safe and effective and also they should also be considered with an optimistic approach and an optimistic view as they can obtain very brilliant responses in many cases.
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