Current treatment of follicular and low-grade non-Hodgkin's lymphoma

Patients with low-grade non-Hodgkin's lymphoma (NHL) have a median survival of 4-8 years from diagnosis and a cause-specific survival of about 10-year s. Radiotherapy can be curative in a small proportion of patients with very localized disease, but the majority of patients have advanced disease at d iagnosis and it is not clear that any current therapy is curative in this s ituation. While in many instances patients with high-grade NHL are cured by chemotherapy, those with low-grade NHL, despite impressive response rates, almost invariably relapse. A 'watch-and-wait' strategy can therefore delay the onset of chemotherapy by 2-3 years, without affecting survival. Result s with autologous stem cell transplantation have been similarly disappointi ng to date. Rituximab is a human-mouse chimeric monoclonal antibody that re presents a novel approach to treatment of low-grade NHL, targeting malignan t cells without the side effects associated with chemotherapy. A pivotal st udy has demonstrated a response rate of 56% in relapsed or refractory low-g rade NHL. The relatively benign side-effect profile means rituximab can be used early in the disease process, and in combination with chemotherapeutic regimens and autologous transplantation. Ongoing and future studies will d efine the optimal role of rituximab in treatment of low-grade NHL. [(C) 200 1 Lippincott Williams & Wilkins.].