Considerations with newer regimens for indolent non-Hodgkin lymphoma

Follicular lymphoma (FL) is considered incurable with current therapies and shows a pattern of multiple remissions and repeated relapses. After demonstrations of significant improvements in clinical outcomes with the addition of rituximab to chemotherapy regimens including alkylating agents and anthracyclines, rituximab-containing chemoimmunotherapy strategies have become central to the management of FL. More recently, novel cytotoxic agents such as bendamustine and pixantrone, that circumvent some of the limitations of conventional chemotherapeutic agents, have been developed and are being clinically investigated. These novel agents are showing promising clinical activity alone and in combination with rituximab in indolent lymphomas. In order to further improve the therapeutic index for patients with FL, rituximab is being combined with novel biologic agents such as immunomodulatory cytokines and monoclonal antibodies targeting CD80 and CD22. This article provides a review of newer chemoimmunotherapy strategies in the management of patients with FL.