Defining the role of immunotherapy and radioimmunotherapy in the treatment of low-grade lymphoma

PURPOSE OF REVIEW: To critically assess recent advances in the treatment of indolent non-Hodgkin lymphoma with a focus on immunologically based therapies. RECENT FINDINGS: Modern treatment strategies, including monoclonal antibodies targeting lymphoma-associated antigens, radioimmunotherapy, therapeutic vaccination and allogeneic hematopoietic stem cell transplantation, have the potential to profoundly impact clinical outcomes in indolent lymphoma therapy. The results of randomized phase III trials now indicate that the addition of rituximab to combination chemotherapy prolongs progression-free and overall survival compared to chemotherapy alone. It is anticipated that similar improvements in outcomes will be associated with other immunologic strategies. SUMMARY: Many questions remain unanswered regarding the optimal treatment approach for patients with indolent lymphoma. Randomized phase III trials addressing the key issues in patient management are ongoing. Continued follow-up of treated patients will be required to assess the character and frequency of long-term toxicities, and to provide insights into the best sequencing of treatments. It is likely that combinations of new treatment strategies will have the greatest impact on long-term clinical outcome. New insights into the underlying biology of the indolent lymphomas are anticipated to help guide therapy for individual patients and to provide new therapeutic targets.