Putting Guidance Into Practice: Real-World Approaches to Relapsed/Refractory Follicular Lymphoma

Relapsed/refractory (R/R) follicular lymphoma (FL) presents a complex and evolving challenge for cancer care teams. As patients progress through multiple lines of therapy, clinicians are tasked with balancing efficacy, safety, logistics, and patient preferences—all while coordinating across specialties and care settings. To help teams navigate these decisions, the Association of Cancer Care Centers (ACCC) developed an Effective Practice Guide (EPG) titled Multidisciplinary Approaches to Treating Patients With Relapsed/Refractory Follicular Lymphoma that focuses on practical strategies for delivering high-quality care to patients with R/R FL. 

The EPG highlights several key principles: 

• Patient-centered decision-making that considers values, lifestyle, and support systems 

• Multidisciplinary collaboration among oncologists, nurses, pharmacists, social workers, patient navigators, and advanced practice providers (APPs) 

• Strong partnerships between academic and community practices to ensure seamless referrals and continuity of care. 

While these concepts are critical, they become even more powerful when translated into real-world patient experiences. Two recent stories involving patients with R/R FL illustrate how the guidance outlined in the EPG can be applied in daily practice. 

Aligning Advanced Therapies With Patient Priorities 

Muhamad Alhaj Moustafa, MD, MS, assistant professor of medicine, division of hematology and oncology at Mayo Clinic Florida, recently cared for a younger patient with R/R FL who had reached third-line therapy. The treatment decision centered on whether to pursue chimeric antigen receptor (CAR) T-cell therapy or a bispecific antibody at this clinical juncture. 

CAR T-cell therapy offers the potential for durable remission but typically requires intensive monitoring and hospitalization, with significant logistical challenges for a patient living several hours away and managing responsibilities at home. Bispecific therapy, by contrast, can be administered in the outpatient setting (usually in the maintenance dosing phase) and is generally well tolerated, though it requires ongoing treatment. 

Through multiple conversations with the patient and her family—and close coordination with her community oncologist—the care team at Mayo Clinic Florida engaged in thoughtful shared decision-making. The patient ultimately chose bispecific antibody therapy, a decision aligned with her values, circumstances, and quality-of-life priorities. The pharmacist and nursing teams played an essential role in ensuring safe step-up dosing and remote monitoring. After the initial ramp-up phase, the patient was expected to transition much of her care back to her local oncologist. 

This case underscores the importance of aligning advanced therapies with real-world needs. By honoring patient preferences, fostering multidisciplinary collaboration, and leveraging community partnerships, the team delivered not just appropriate treatment, but also a care plan that respected the patient’s life outside of cancer. 

Building Bridges With Community Providers 

Working at a large academic medical center, Brittney Baer, BSN, RN, patient care nurse coordinator at Vanderbilt-Ingram Cancer Center, emphasizes how critical strong relationships with surrounding community practices are for patients with R/R FL. Open communication and trust between institutions can make the difference between timely access to advanced therapies and missed opportunities for care. 

One patient, whose FL had not responded to traditional chemotherapy, lived about 5 hours from the center. Her local oncologist suspected CAR T-cell therapy might be appropriate and reached out directly to a provider at the academic center. Because of that established relationship, the referral process was seamless; the community oncologist contacted the referral team, and the patient was seen the following week to begin the pretreatment workup. 

Without that connection, the referral might have been delayed—or never initiated. This story highlights how proactive outreach and sustained collaboration between academic and community providers are essential for ensuring equitable access to cutting-edge therapies. For patients with R/R FL, those bridges can translate directly into better care delivery. 

Key Takeaways 

Together, these 2 stories illustrate how the principles outlined in the R/R FL EPG can be successfully applied in day-to-day oncology practice. By moving beyond theory into real-world patient care, they demonstrate how patient-centered decision-making, multidisciplinary teamwork, and strong community-academic partnerships translate into meaningful benefits for patients and care teams alike. 

• Patient-centered care requires more than clinical expertise. It demands empathy, respect for individual values, and flexibility in treatment planning. 

• Multidisciplinary teamwork ensures that pharmacists, nurses, advanced practice providers (APPs), patient navigators, and physicians work closely together to deliver complex therapies safely and effectively. 

• Community-academic partnerships break down barriers to access and keep patients at the center of decision-making, no matter where they live. 

As the R/R FL treatment landscape continues to evolve with novel therapies such as CAR T-cell therapy and bispecific antibodies, these practices are not just recommended, they are increasingly essential. The ACCC R/R FL Effective Practice Guide offers actionable tools and strategies for cancer care teams looking to strengthen collaboration, streamline communication, and deliver care that truly reflects patient needs.