Increasing treatment options in indolent non-Hodgkin's lymphoma

There is currently no standard first-line treatment for indolent non-Hodgkin's lymphoma (NHL) because there is no curative treatment. In asymptomatic patients, treatment with chemotherapy does not improve survival compared with a "watch and wait" approach. Improved treatment strategies, with curative intent, are thus required for indolent NHL. Rituximab is effective and well tolerated in the treatment of indolent NHL and can be considered for asymptomatic patients, where the side effects of chemotherapy may outweigh the benefits. In addition, rituximab does not compromise the use of subsequent chemotherapy in patients who relapse. A study of rituximab monotherapy in patients with low-tumor-burden follicular lymphoma has shown high rates of both clinical remission and molecular remission (clearance of bcl-2-positive cells from blood and/or bone marrow). After 2 years, half the patients relapsed, indicating that improved strategies are still required. Efforts to improve the efficacy of rituximab have included repeated administrations of the antibody and combined administration with chemotherapy or interferon-alpha2a. The optimal role of rituximab in first-line therapy for indolent NHL will be determined through randomized clinical trials.