Indolent lymphomas: current and emerging treatment approaches

The introduction of targeted therapy in combination with chemotherapy has greatly advanced the treatment of patients with indolent lymphomas in recent years. Most commonly studied in patients with follicular lymphoma, the monoclonal antibody rituximab has not only improved the response rate and progression-free survival for both treatment-naive and relapsed/refractory patients, it is also beginning to demonstrate an improvement in overall survival. These benefits are challenging many of the standard treatment approaches in follicular lymphoma and offer hope that treatment of the disease may soon advance from being palliative to curative. Ongoing research seeks to determine how best to use targeted agents in the setting of indolent lymphoma, either concurrently with chemotherapy or sequentially following the administration of chemotherapy. Various studies aim to define the utility of rituximab as a long-term maintenance treatment in several follicular lymphoma settings, as well as its benefit in autologous stem cell transplantation. In addition to these immunotherapy studies, the use of radioimmunotherapy is also being explored for its efficacy as a frontline and consolidation treatment approach. As additional molecular and targeted therapeutics advance through clinical trials, future treatment strategies for indolent lymphomas will likely involve the addition of these newer therapeutics to immunochemotherapy based on the individual risk profile of a patient.