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JOSE VILLASBOAS: When we are looking at a biopsy of a patient suspected to have lymphoma, and we see that these cells are mostly of a small size usually found in aggregates that sometimes respect the distribution of follicles-- that's why the name "follicular lymphoma"-- the vast majority of the patients will have a B-cell lineage non-Hodgkin lymphoma, or a BNHL. Inside that category, I normally divide that between aggressive B-cell non-Hodgkin lymphomas, and indolent, or slow growing, B-cell non-Hodgkin lymphomas. And inside that group, the slow growing kind is where we find follicular lymphomas and other indolent B-cell non-Hodgkin lymphomas.

Any time that you see a case of lymphoma, I would recommend that you have that case reviewed by a center with experience in treating this particular type of cancer. Once you give that label of the lymphoma diagnosis and the subtype, that typically dictates everything else you do from that point onward. For most cases of follicular lymphoma, cure is not the goal. The goal is disease control, with some exceptions.

For example, if you do see a case of follicular lymphoma that is localized to one or two lymph nodes in one specific area, there is a chance-- not 100%, but a fair chance-- of cure with radiation therapy. Most patients will present with more than one lymph node area, or multiple areas, or even involvement of lymph nodes, both sides of the diaphragm, the spleen and the bone marrow. And in those cases, I typically tell the patient that we're going to try to control this and there are great tools to achieve that.

I am personally excited about anything related to using the immune system. And this includes not only CAR T cell therapy, and that's actually already approved for patients with relapsed follicular lymphoma, but we're testing now new variations of cellular therapy different types of CAR T cells looking at different targets. And I expect this will be very useful and exciting for patients with follicular lymphoma.

This disease is a multifaceted disease. It has different behaviors and biologies at different times, and requires that we be flexible and nimble in terms of going to and from different treatments. And having that access to a multidisciplinary team definitely is in the benefit of the patient.

Patients who are traveling to be here obviously would like to go back home. Our practice is a very collegial practice, working hand-in-hand with the local providers. I see a patient, I review the case. I confirm the diagnosis, I confirm the stage, and then I design a treatment plan, keeping in mind that the patient wants to return home.

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