New treatment strategies in lymphomas: aggressive lymphomas

This review will cover the use of these monoclonal antibodies alone or in combination with chemotherapy for the treatment of aggressive lymphomas. Rituximab, an unconjugated anti-CD20 chimeric antibody, is certainly the most widely used but other unconjugated or radiolabeled monoclonal antibodies may catch up quickly. Rituximab combined with chemotherapy allows increasing the complete response rate, to decrease progression during treatment or relapse, to increase duration of response, event-free survival and overall survival. This benefit is now demonstrated in several randomized studies in different settings. Less data are available for the use of Rituximab in maintenance after chemotherapy or autologous transplant. The use of monoclonal antibodies (MAb) for the treatment of lymphoma patients appeared some 7 years ago and, firstly, they have been developed for so-called 'low-grade' or indolent lymphomas. Murine antibodies have been used with toxin or isotopes attached to them and, in this case, the antibody is used to specifically transport the active agent, often a radionucleide, to lymphoma cells. In the case of unmodified, naked, monoclonal antibodies, such as rituximab, the chimeric human-mouse antibody fixes the antigen on the membrane of lymphoma cells with the murine antibody part and stimulates the immune host mechanisms through the human Fc part. The fact of fixing the antigen on the cell surface may also trigger a cascade of biologic events leading to the cell death through the apoptotic process.