Title: Mosunetuzumab for treating relapsed or refractory follicular lymphoma [ID3931]
Funder: Department of Health and Social Care

Abstract: Lymphomas are cancers of the lymphatic system, which is part of the immune system and are divided into Hodgkin and non-Hodgkin lymphomas. Non-Hodgkin lymphomas are a diverse group of conditions which can affect either of the 2 main types of lymphocytes, T lymphocytes or B lymphocytes. Non-Hodgkin lymphomas can be low grade, or indolent, meaning they are slow growing, or high-grade, meaning they grow faster and more aggressively. [1]_x000D_ _x000D_ Follicular lymphoma is a type of indolent, low grade lymphoma which affects Blymphocytes. People with this condition typically present with painless lumps (enlarged lymph nodes) in the neck, armpit or groin although there may be additional symptoms such as night sweats and recurrent fevers in some people. [2]_x000D_ _x000D_ Follicular lymphomas are commonly staged from I (best prognosis) to IV (worse prognosis) and the staging depends on how many groups of lymph nodes are affected, where they are in the body, the size of the areas of lymphoma and whether other organs outside of the lymphatic system such as the bone marrow or liver are affected.[3]_x000D_ _x000D_ In England in 2018 there were 11,944 diagnoses of non-Hodgkin’s lymphoma and 2329 (19%) of those were follicular lymphoma. [4] The 5-year survival rate for those diagnosed with follicular lymphoma is around 90%. [5] Duration of response to chemoimmunotherapy and survival decreases with each subsequent relapse of follicular lymphoma.[6]_x000D_ _x000D_ Clinical management for relapsed and refractory follicular lymphoma includes: _x000D_ _x000D_ • NICE technology appraisal 137 recommends rituximab either alone or in combination with chemotherapy as a treatment option for people with relapsed or refractory stage III or IV follicular non-Hodgkin’s lymphoma. _x000D_ • NICE technology appraisal 629 recommends obinutuzumab with bendamustine followed by obinutuzumab maintenance monotherapy as an option for treating follicular lymphoma that did not respond or progressed up to 6 months after treatment with rituximab or a rituximab-containing regimen. _x000D_ • NICE technology appraisal 627 recommends lenalidomide with rituximab as an option for previously treated follicular lymphoma (grade 1 to 3A) in adults. _x000D_ • Consolidation with autologous or allogenic stem cell transplantation can also be offered for people with follicular lymphoma, in second or subsequent remission (complete or partial), who meet the eligibility criteria._x000D_ _x000D_ References_x000D_ _x000D_ 1. Cancer Research UK. How doctors group non-Hodgkin lymphomas. Accessed February 2022._x000D_ 2. Cancer Research UK. Symptoms. Accessed February 2022._x000D_ 3. Cancer Research UK. Stages of non-Hodgkin lymphoma. Accessed February 2022._x000D_ 4. Public Health England. Cancer registration statistics, England: final release, 2018. Accessed February 2022._x000D_ 5. Cancer Research UK. Survival. Accessed February 2022._x000D_ 6. Rivas-Delgado A, Magnano L, Moreno-Velázquez M et al. Response duration and survival shorten after each relapse in patients with follicular lymphoma treated in the rituximab era. British Journal of Haematology. 2018;184(5):753-759.

Lay abstract: To appraise the clinical and cost effectiveness of mosunetuzumab within its marketing authorisation for treating relapsed or refractory follicular lymphoma.

Research activity codes: 6.1 PHARMACEUTICALS
Health categories: CANCER AND NEOPLASMS