Follicular lymphoma (FL) is the most frequent indolent non-Hodgkin
lymphoma. Therapeutic strategies vary from withholding treatment to aggressive
chemoimmunotherapy regimes, and stem cell transplantation, depending on the stage
and risk stratification at diagnosis. A prominent role of the microenvironment in FLcell
survival and lymphomagenesis has been brought to light and consequently the
manipulation of the FL-cell niche is progressively becoming an important therapeutic
tool in FL. Chemotherapy agents are no longer under the spotlight, leaving the main
role to immunotherapeutic strategies and targeted therapy that aim towards disease
control with minimal side-effects and sequelae. Immunotherapy with monoclonal
antibodies, radioimmunotherapy and vaccines, has resulted in increased response rates
and survival in FL patients.
Adoptive immunotherapy is an emerging strategy for FL treatment, aiming to exploit
the immune system's natural tendency to attack tumoral cells. AntiCD20 monoclonal
antibodies have become the backbone of first line and relapse treatments combined
with chemotherapy regimens. Anti-idiotype vaccines are the best developed active
immunotherapy strategy, with proven efficacy in patients with FL on first relapse. The
other vaccine types (Dentritic cells, proteoliposomal or DNA) are still in preclinical
development. Adoptive cell transfer (NK cells, LAK and effector T-lymphocytes),
chimeric-antigen receptor (CAR) engineered T-cells and Bi-specific T-cell engaging antibodies (BiTE) for passive immunotherapy remain also experimental approaches,
although promising pre-clinical results have recently become available.
The following chapter will summarize FL biology and conventional treatment with
immunochemotherapy, with a final section focusing specifically on novel
immunotherapy strategies (active and passive) for the treatment of FL.
Keywords: Adoptive cell-therapy, Anti-idiotype vaccines, Dentritic-cell vaccines,
Follicular lymphoma, Immunotherapy, LAK cells, Monoclonal antibodies, NK
cells, Radioimmunotherapy, Vaccines.
