New treatment approaches to indolent non-Hodgkin's lymphoma

Disseminated indolent non-Hodgkin's lymphoma (NHL) is considered incurable with conventional chemotherapy regimens, and more than 50% of patients die within 5 years of their first relapse. Therefore, newer treatment approaches have been used to try to improve survival and ultimately provide a cure for patients with disseminated indolent NHL. The anti-CD20 monoclonal antibody rituximab has been extensively evaluated and is now an integral component of many treatment strategies. The activity of rituximab was first shown in the pivotal trial in patients with relapsed and refractory low-grade and follicular lymphoma. More recent studies have shown somewhat higher activity of rituximab when used first-line, with further improvements with maintenance therapy. Rituximab in combination with chemotherapy has been shown to achieve high response rates, and two prospective randomized studies from the German Low-grade Lymphoma Study Group have shown significantly higher response rates and longer survival for patients receiving rituximab concurrently with chemotherapy compared with those receiving chemotherapy alone. Further data from ongoing phase III studies are still needed to determine whether rituximab can help alter the natural history of indolent NHL, and longer follow-up of these patients will help determine the optimal role for rituximab in treatment of indolent NHL.