Managing 3rd-Line R/R FL: Recognizing Progression, Performing Rebiopsies, and Rechecking for CD20 Positivity

EP: 1.Overview of R/R FL: Focus on the 3rd-Line Setting and Beyond START

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EP: 2.Managing 3rd-Line R/R FL: Recognizing Progression, Performing Rebiopsies, and Rechecking for CD20 Positivity

Summary for Physicians:

Topic: Role of Rebiopsy and CD20 Reassessment in Suspected Progression of Follicular Lymphoma After Second-Line Therapy

Key Points:

1. Rebiopsy at Suspected Progression:

• Rebiopsy is generally recommended when progression is suspected after second-line therapy in relapsed/refractory follicular lymphoma (R/R FL).

• The purpose of rebiopsy is to confirm true progression, rule out a transformation to a more aggressive histology (eg, diffuse large B-cell lymphoma), and to reassess disease biology, which can change over time.

• Histologic transformation may require a different therapeutic approach, making tissue confirmation critical for guiding treatment decisions.

1. Reassessment of CD20 Expression:

• In addition to confirming progression or transformation, rechecking for CD20 positivity is an important part of the rebiopsy process.

• Loss of CD20 expression, although relatively uncommon, can occur following anti-CD20 monoclonal antibody therapy and may affect the efficacy of subsequent treatments.

• Knowing the CD20 status is essential, especially when considering further anti-CD20-based therapies, such as rituximab or obinutuzumab.

Clinical Implication: A rebiopsy at the time of suspected disease progression provides vital diagnostic and prognostic information, including the possibility of transformation and CD20 status. These data directly inform subsequent therapeutic decisions and can help tailor third-line or investigational treatments in patients with R/R FL.