b'Better Understanding Leads to New Treatment Options for Follicular LymphomaAlready a presumptive condition for Vietnam-era veterans exposed to Agent Orange and military personnel who were at Camp Lejeune in the mid-20th century, follicular lymphoma is also one of the presumptive conditions associated with burn pits for Gulf War era and post-9/11 veterans under the new PACT Act. Recent advances have provided a greater understanding of the biological changes that precede the development of FL, a type ofnon-Hodgkin lymphoma, and treatment options are improving.By Annette M. BoyleSILVERSPRING,MDWiththepassageoftheResearchers at the Walter Reed Army Institute of Sgt. 1st Class Heath Robinson Honoring our PromiseResearch in Silver Spring, MD, the National Cancer toAddressComprehensiveToxicsActof2022Institute in Rockville, MD, and other leading can-(PACT Act), Congress added follicular lymphomacer centers, examined subtle alterations in immune to the presumptive conditions associated with burnfunction in search of biomarkers that could herald pits and other exposures for Gulf War era and post- or presage development of non-Hodgkin lymphomas 9/11 veterans. A type of non-Hodgkin lymphoma,(NHL) including FL. 1the cancer was already a presumptive condition for Vietnam-era veterans exposed to Agent Orange andSubtype Variabilityservicemembers exposed to contaminated water atPreviousstudiesindicatedthatelevatedlevelsof Camp Lejeune from 1953-87.soluble CD27 and CD30 along with chemokine li-Follicular lymphoma accounts for 10% of all non- gand-13 (CXCL13) were associated with high risk Hodgkinlymphomas,andapproximately15,000of NHL. The precise time frame that would reflect cases are diagnosed in the United States each year.disease-induced rather than etiologic effects in not Whiletypicallyanindolentdiseasethatmightknown for most subtypes, even though the differ-never require treatment in up 30% of patients, itences in aggressiveness would suggest subtype-spe-transforms into a much more aggressive disease,cific variability in early stages, the team said.typically diffuse large B-cell lymphoma, in aboutTo provide clarity on the relationship, the research-2% of cases.ersconductedapooledanalysisofeightnested For most patients with follicular lymphoma (FL),case-control studies that focused on one or more of however, the disease becomes a chronic conditionthese markers. The analysis included 2,455 cases with no cure. While initial therapy often produces aand 3,310 controls. The team found that the odds remission of two years or more, many patients willratioassociatedwiththebiomarkersvariedsig-experience a relapse or recurrence that requires addi- nificantly between the subtypes. Levels of sCD27 tional lines of therapy. weremuchmorestronglyassociatedwithother Recentadvanceshaveprovidedagreaterunder- subtypes of NHL than with follicular lymphoma, standing of the biological changes that precede thebut the odds ratios associated with CXCL13 varied development of FL and may provide biomarkers forless across the subtypes and not at all for sCD30. the disease. In addition, new therapies provide addi- Modelingthethreeimmunemarkerssimultane-tional treatment options suitable for patients of vary- ously found sCD30 was only associated with FL ing health status, age and preferences. and diffuse large B-cell lymphoma (DLBCL).46'