Rituximab in the management of follicular lymphoma

Abstract

The incidence of follicular lymphoma, a low-grade malignant B-cell lymphoma, is increasing in most Asian populations. Follicular lymphoma is generally considered to be indolent with a life expectancy of approximately 10 to 14 years. However, it is characterised by repeated relapse, and disease progression typically occurs 3 to 5 years after initial treatment. Rituximab, a monoclonal antibody, demonstrates consistent survival benefits when administered as part of a first- and second-line immunochemotherapy. Consequently, rituximab is now considered the standard of care for follicular lymphoma, and is recommended as the first-line therapy for early-stage asymptomatic disease. Available evidence also demonstrates survival benefits for rituximab as maintenance therapy in patients who have responded to induction therapy with either frontline rituximab or chemotherapy. Improved survivals in patients receiving rituximab-based first-line induction and maintenance therapies suggest that this treatment strategy may be preferable to adopting a watch-and-wait policy in patients with asymptomatic follicular lymphoma. While rituximab has improved treatment outcomes in follicular lymphoma patients, the appropriate timing, dosing and duration of therapy remain to be clarified in future clinical trials. Given the indolent nature of follicular lymphoma and the relatively long life expectancy associated with this disease, prognostic tools have an important role in guiding clinical decisions based on individual patient risk. © 2011 Hong Kong College of Radiologists.