Treatment of follicular lymphoma--a review

Follicular non-Hodgkin's lymphomas are indolent malignancies that have to be treated repeatedly when symptoms occur. Traditionally, several chemotherapeutic schedules are used. As a result there is a progressive shortening of the disease-free periods and no chemotherapeutical treatment has resulted in a survival benefit so far. The introduction of rituximab, a monoclonal anti-CD 20 antibody, and the association of rituximab with first-line chemotherapy has resulted in a prolongation of the progression-free survival (PFS) and seems to have an impact on (overall survival) OS. The low toxicity profile has even made maintenance therapy with rituximab possible. Trials with rituximab in maintenance suggest a survival benefit. The most optimal schedule of administration and the pharmaco-economical implications are, however, not obvious yet. Autologous stem cell transplantation (SCT) at first remission is another treatment option that has to be re-evaluated. Apart from that there is also the possibility of radio-immunotherapy, of which the advantage will have to become clear during follow-up of recent phase III trails.