Maintaining life in indolent lymphoma from evidence-based medicine to clinical practicel

Patients with indolent non-Hodgkin’s lymphoma (NHL) respond well to initial treatment, but relapses are expected and, with sequential recurrences, the quality and durability of responses diminish. The introduction of CD20 antibody therapy has provided a unique and effective new treatment and promising improvements in patient outcomes are now being observed in large-scale clinical trials in combination with standard therapy. When cure is not attainable, an important goal of therapy is to prolong periods of symptom-free remission after successful induction treatment. A substantial body of evidence now shows that rituximab-based induction therapy for patients requiring treatment improves response rates, quality of response and time to progression, and, in some studies, survival. Because of its efficacy, tolerability and convenient administration, rituximab is also an excellent candidate for maintenance therapy. Efficacy and safety data in relapsed indolent lymphoma from the European Organisation for Research and Treatment of Cancer (EORTC) 20981 and German low-grade lymphoma study group (GLSG) trials will be examined, which support the use of rituximab maintenance therapy to sustain remission. Rituximab is well tolerated and associated side effects generally have been easily managed and reversible. However, practical and theoretical considerations pertinent to the use of maintenance therapy in indolent lymphoma, such as immunosuppression, must be evaluated and based on available knowledge and evidence. The introduction of rituximab in induction and in maintenance therapy represents progress in the treatment of indolent NHL patients, who now have better prospects of achieving more durable disease control.