Early relapse should be carefully considered when oncologists and patients make decisions about treatment, concludes a team led by Carla Casulo, oncologist and assistant professor of Medicine at the University of Rochester, NY, writing in the Journal of Clinical Oncology.

While most follicular lymphoma patients can expect to live 20 years, a distinct group of around 1 in 5 patients consistently experiences a return of the blood cancer within 2 years of receiving even the most up-to-date treatment.

The study is the first to confirm that this group is likely to experience poor survival - 50% of these patients die within 5 years.

Prof. Casulo says these early relapsing patients may have a disease with distinctly different biology, and notes:

"Through research we have confirmed that all relapsed patients are not equal, and therefore should not be approached the same at diagnosis nor at the time of relapse in terms of therapies."

Gene-expression profiling 'will be important to understand high-risk group'

The researchers came to their conclusions after analyzing data from 588 patients with stage 2-4 follicular lymphoma. They also confirmed their findings in an independent patient cohort.

Prof. Casulo says it is critical to predict which follicular lymphoma patients are likely to relapse early, and:

"We believe that targeted sequencing or gene-expression profiling will be important to understanding how to improve the outcomes of this group."

The National Cancer Institute is starting to develop clinical trials for this high-risk, early-relapsing group of patients.

Lymphomas - cancers of the lymphatic system - are divided into Hodgkin lymphoma and non-Hodgkin lymphoma, of which follicular lymphoma is the second most common.

Follicular lymphoma develops when the body makes abnormal B-lymphocytes - a type of white blood cell. The affected cells accumulate in lymph nodes.

In the US, around 15,000 people a year are affected by follicular lymphoma.

You can find out more about investigational treatments for all types of lymphoma, including follicular lymphoma, that are currently being evaluated at cancer treatment centers nationwide, from the Lymphoma Research Foundation's clinical trials information service.

In December 2014, Medical News Today reported how a team of researchers had identified some early gene changes that precede blood cancer. They suggested their findings could open new ways to research blood cancers and identify high-risk groups.

Written by Catharine Paddock PhD