Purpose of review
Although outcomes for patients with follicular lymphoma have improved with chemoimmunotherapy, the disease remains incurable. There is a wide variation in survival, and although the Follicular Lymphoma International Prognostic Index helps to risk-stratify patients, there is a need for robust biomarkers of disease outcome. Most patients will succumb to the emergence of chemoresistance or transformation to diffuse large B-cell lymphoma and there is a need for new treatment approaches in this disease.
Gene expression profiling studies and immunohistochemical analyses have highlighted the importance of the tumor microenvironment in follicular lymphoma. There have, however, been conflicting results regarding the prognostic significance of specific subsets of immune cells in follicular lymphoma. Recent studies have highlighted the interaction of specific treatment protocols and the immune environment on outcome. We are now beginning to uncover the molecular basis of the complex interactions that occur between follicular lymphoma cells and the immune microenvironment.
There is an active interaction between follicular cells and the microenvironment that determines the clinical behavior, prognosis, and response to specific treatment protocols. As we have a more complete understanding of this complex interaction it is the likely that the tumor microenvironment itself may become a target of therapy, or that therapy might be tailored based upon the specific immune microenvironment of the biopsy.