Abstract
Follicular lymphomas form a distinctive group of malignant lymphomas with a characteristic course of ever relapsing disease, that ultimately - after histologic transformation - causes the patients' death years after diagnosis. Treatment of such patients remains a dilemma. Initially, a wait and see policy is allowed in an asymptomatic patient. Once therapy is indicated, temporal responses are seen to diverse treatment modalities and regimens. Unfortunately, in general, only prolongation of progression-free but not overall survival is achieved by several therapies. An exception to this rule seems to be the intensification of treatment to myelo-ablative therapy followed by allogeneic stem cell transplantation. In contrast to the lack of improvement of clinical outcome of patients with follicular lymphoma, diagnostics have in fact greatly gained sensitivity during the past decades. With the introduction of real-time polymerase chain reaction in molecular diagnostics, cells carrying the chromosomal translocation t(14;18), characteristic for follicular lymphoma, can be quantitated very sensitively. The present thesis focuses on the potential role of molecular diagnostics, i.e. the quantitative monitoring of t(14;18) positive cells, in the treatment of follicular lymphoma patients. Analysis of circulating lymphoma cells might be valuable in early evaluation of the efficacy of (new) therapies, because it may take years before clinical observations can show any survival benefit, due to the indolent course of disease. Until now questions remain on the clinical significance of the presence, and if so in what quantity, of circulating lymphoma cells. Studies presented here try to rationalise the use of molecular diagnostics in follicular lymphoma
