Emerging treatments for indolent lymphoma

Non-Hodgkin lymphomas (NHLs) comprise a diverse group of lymphatic malignancies of primarily B-cell origin, which are steadily increasing in prevalence worldwide. Approximately 63,190 new cases of NHL are expected to be diagnosed in the United States in 2007, representing 4% of all cancers. Further, the annual incidence rate of NHL in 2000-2004, estimated from the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute, was 19.3 cases per 100,000 persons. Of these, the indolent NHLs, although initially responsive to a variety of therapeutic regimens, have a continuous relapsing nature and are essentially incurable. Over the past decade, the availability of monoclonal antibodies has revolutionized the treatment of patients with various types of NHL. To date, the most noteworthy agent of this type has been rituximab, an antibody directed against the CD20 antigen found on the majority of B-cell lymphomas. Rituximab is associated with improved and durable responses as a single agent and in combination with chemotherapy for patients with newly diagnosed or relapsed/refractory NHL. Recent data suggest an improvement in survival in recently diagnosed patients who have had access to rituximab therapy and provide new insights into the use of rituximab in frontline combination chemotherapy and as maintenance therapy. Other emerging therapeutics include new chemotherapeutics, small-molecule and monoclonal antibodies, radioimmunotherapy, apoptosis-inducing agents, and immunomodulators.