Combinations of biological agents in non-Hodgkin’s lymphomas

The traditional approach to patients with indolent non-Hodgkin ‘s lymphomas (NHL) has included a single alkylating agent, a combination of drugs, such as cyclophosphamide, vincristine and prednisone (CVP), or with adriamycin (CHOP), or CHOP, without evidence of an advantage among these approaches.1 However, the availability of active monoclonal antibodies for the treatment of non-Hodgkin’s lymphomas (NHL) has revolutionized the treatment of patients with these disorders. Rituximab, a chimeric anti-CD20 monoclonal antibody, induces responses in about 50% of patients with relapsed/refractory follicular and low-grade NHL.2 The response rate increases to about 70% in previously untreated patients.3-5 Nevertheless all patients eventually relapse and require alternative therapies. Increasing the dose or dose intensity or number of infusions has failed to achieve more than a few transient partial responses.6-8