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Treatment of follicular lymphoma: current status

With the recent proliferation of treatment options for patients with follicular lymphoma (FL), median survival has been shown to have improved, from 84 months between 1983 and 1989 to 93 months between 1993 and 1999. Nevertheless, relapse is common in this patient group, and treatment options that extend the duration of remission without increased toxicity are still required. Rituximab has made a major contribution to the treatment of patients with FL, improving outcomes and making new treatment schedules possible. It is now a standard practice to administer rituximab with first-line combination chemotherapy in patients with FL. In addition, a number of current trials are examining the potential role of rituximab maintenance therapy in improving outcomes in FL. However, at present it is not clear which schedules or combinations are the most effective, and further randomised controlled trials of treatment strategies incorporating rituximab are needed to provide the evidence that will allow clinicians to maximise the potential of this drug. Second-line options for the treatment of FL include allogeneic stem cell transplantation, radioimmunotherapy targeted to CD20 and, in selected patients, autologous stem cell transplantation. New treatment approaches for FL currently being investigated in the second-line setting include the proteasome inhibitor, bortezomib and novel anti-CD20 monoclonal antibodies.