'Watch and wait' as initial management for patients with follicular lymphomas: still a viable strategy?

Observation until the development of symptoms, or 'watch and wait', has long been a proposed management technique for patients with indolent lymphomas. However, investigators have found that there may be differences in outcomes for various patient groups according to histopathology, clinical features of the disease, biologic factors as yet to be fully recognized, and type of initial therapy offered. Recently, investigators from the UK National Cancer Research Institute reported that progression-free results were significantly improved when asymptomatic patients with indolent follicular lymphomas received initial therapy with single-agent rituximab rather than when they underwent observation alone. These results were further improved when they received maintenance rituximab. Time to chemotherapy was also longer when these patients received initial therapy with rituximab, thereby delaying the need for such treatment. However, overall survival rates for patients who received rituximab as initial therapy were similar to those for patients who underwent initial 'watch and wait'. Future studies should concentrate on risks of such management, including cost effectiveness of such treatments and development of resistance to subsequent therapies.