Rituximab therapy for follicular lymphoma: a comprehensive review of its efficacy as primary treatment, treatment for relapsed disease, re-treatment and maintenance.

BACKGROUND: Advances in the treatment of follicular lymphoma (FL) have been achieved through the development of newer combination regimens, mostly based upon purine analogs and/ or monoclonal antibodies, as well as recent progress in the area of stem cell transplantation. INFORMATION SOURCES: These advances have increased the need to obtain consensus regarding treatment priorities from the various options available, ranging from the traditional palliative approach through to the novel regimens available including stem cell transplantation. STATE OF THE ART: The apparent synergism between chemotherapy and rituximab, which facilitates the achievement of complete clinical (CR) and molecular remission (MR), together with the possible feasibility of maintenance and re-treatment with rituximab have increased the interest in the use of this drug as primary treatment for FL. This review summarizes the available literature and deals with the role of rituximab in refractory/relapsed FL as well as in previously untreated FL patients. The improvement in remission rates and response duration associated with immunotherapy are contrasted with the potential risks, such as the development of rituximab resistance, as well as other less recognized complications related to altered humoral immunity. PERSPECTIVES: Despite all the advances reported, treatment might still have to be individualized for patients with FL, until evidence of an important survival advantage for rituximab over chemotherapy is established. The possible role of autotransplantation for FL and the use of rituximab is also reviewed.