Confronting Knowledge Gaps Concerning Relapsed/Refractory Follicular Lymphoma

A learning opportunity provided by i3 Health has demonstrated significant knowledge gains and proficiency regarding the optimization of treating patients with relapsed/refractory (R/R) follicular lymphoma (FL).

Non-Hodgkin lymphoma is one of the most prevalent cancers in the United States, with a 2022 estimate of around 80,470 people to be diagnosed, with 20,250 of these cases expected to be fatal. One in five of these cases will be FL, which is usually a slow-growing lymphoma but has the chance of growing quickly. Although many cases of FL respond well to treatment, most patients are not cured. Considerable gaps and research needs remain in the treatment of R/R FL. Typically, lymphomas are evaluated using the International Prognostic Index (IPI) risk score, but due to the slow-growing nature of FL, the Follicular Lymphoma International Prognostic Index (FLIPI) was created to better predict prognosis. Despite this, further research, knowledge, and proficiency are required when understanding, diagnosing, and managing FL.

To confront the knowledge gaps concerning the management and treatment optimization of patients with R/R FL, i3 Health provided a continuing medical education (CME)–approved online Virtual Tumor Board activity, Optimizing Personalized Care Plans for Patients With Relapsed/Refractory Follicular Lymphoma. This activity was led by Loretta Nastoupil, MD, Associate Professor of Medicine at MD Anderson Cancer Center; Francisco Vega, MD, PhD, Professor of Pathology at MD Anderson Cancer Center; and Reem Karmali, MD, MS, Associate Professor of Medicine at Northwestern Memorial Hospital. The activity was supported by an independent education grant from Epizyme.

A total of 255 learners participated in the activity, with 238 completing the activity for credit. The online activity was made available November 2, 2020, through November 1, 2021. Most learners who attended were registered nurses (n=219), followed by physicians (n=15), nurse practitioners (n=7), advanced practice nurses (n=3), pharmacists (n=3), physician assistants (n=2), clinical nurse specialists (n=1), and those who chose “other” as their profession (n=5). Each learner was given a pretest prior to the beginning of the activity, followed by a posttest, which consisted of the same questions, upon the conclusion of the activity.

The baseline data collected demonstrated shortcomings of knowledge and confusion over therapeutic approaches to optimize treatment and survival of individuals with R/R FL. The data collected included evaluation of knowledge of the following topics: assessing emerging efficacy and safety data on novel therapeutic approaches for patients with R/R FL, discussing the implications of progression of disease within 24 months (POD24) status in therapeutic decision making for patients with R/R FL, and applying strategies to optimize treatment experiences and outcomes for patients with R/R FL.

Prior to the start of the activity, the pretest revealed that 35% of learners were able to successfully identify that bendamustine monotherapy would not prolong a patient’s overall survival compared with bendamustine/obinutuzumab followed by obinutuzumab maintenance; 30% were able to identify lenalidomide/rituximab as the best next line of treatment following treatment with obinutuzumab/CHOP; 30% successfully recognized that a patient who experienced POD24 is more likely to have a response to obinutuzumab/lenalidomide compared with a patient who did not relapse early but has refractory disease; 29% recognized neutropenia as the grade ≥3 adverse event a patient is most likely to experience on duvelisib; and only 28% recognized nausea as the any-grade adverse event a patient is most likely to experience when being treated with tazemetostat.

Significant knowledge and proficiency were gained during the activity, as revealed by the posttest data, where each topic saw a substantial increase in successful identification of the correct answer: 64% more learners were successful when identifying the efficacy of bendamustine/obinutuzumab for CD20-positive FL; 65% more learners successfully identified the efficacy of lenalidomide/rituximab for CD20-positive, EZH2 wild-type FL; 65% more were successful in recognizing the POD24 prognostic status for obinutuzumab/lenalidomide response; and 63% more were successful when understanding both duvelisib and tazemetostat adverse events.

Upon completion of the activity, 81% of participants felt more confident in treating their patients with R/R FL, and 83% felt the material presented would be used to improve the outcomes of their patients with R/R FL.

The results revealed by the posttest data confirm the effectiveness of the provided educational content and show the significant increase in learners’ knowledge and competence regarding strategies for the treatment of R/R FL. i3 Health has determined that the multidisciplinary team may benefit from CME/NCPD activities that provide education of the management and treatment of R/R FL on the following topics: novel therapeutic agents, treatment selection, and adverse event management.

For More Information

i3 Health (2022). Optimizing personalized care plans for patients with relapsed/refractory follicular lymphoma: activity outcomes report. Data on file.

American Cancer Society (2022). Survival rates and factors that affect prognosis (outlook) for non-Hodgkin lymphoma. Available at:

American Cancer Society (2022). Types of B-cell lymphoma. Available at:

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