Rituximab as first-line monotherapy in low-grade follicular lymphoma with a low tumor burden

Patients with follicular lymphoma and a low tumor burden have a median over all survival of more than 10 years. Toxic conventional chemotherapy regimen s are inappropriate in these patients as they do not improve overall surviv al and the patients do not require palliation of symptoms. However, as most of these patients will ultimately die of their lymphoma, new therapies, wi th curative intent, are required. Rituximab is a human-mouse chimeric monoc lonal antibody that has shown efficacy in patients with non-Hodgkin's lymph oma (NHL). The benign tolerability profile of rituximab makes it a suitable candidate for first-line treatment of follicular NHL patients with a low t umor burden. In a trial of 49 patients, 73% achieved a clinical response (2 6% complete response) with rituximab treatment. Molecular studies showed th at 57% of patients achieved molecular remission (clearance of the bcl-2 mol ecular translocation from the blood, evaluated by polymerase chain reaction ), 62% of these remaining bcl-2(-) far at least 1 year. There was a good co rrelation between molecular and clinical responses, with patients failing t o achieve a molecular response at higher risk of disease progression. Ritux imab monotherapy is therefore an effective and well-tolerated treatment for patients with low-grade lymphoma and a low tumor burden. [(C) 2001 Lippinc ott Williams & Wilkins.].