Rituximab maintenance versus radioimmunotherapy consolidation in follicular lymphoma: which, when, and for whom?

Follicular lymphoma (FL), the most common indolent lymphoma, typically presents in advanced-stage disease. Currently available therapy does not generally result in a curative outcome, but survival in FL has improved since the introduction of anti-CD20 monoclonal antibody immunotherapy. The goals of treatment include prolongation of survival and effective palliation of symptoms while limiting the duration of therapy to minimize adverse effects and reduce costs. Multiple rounds of treatment over many years characterize the clinical course for most patients with FL. Rituximab in combination with chemotherapy has been shown to improve overall survival in patients with FL compared with chemotherapy alone. Rituximab maintenance further improves disease control in patients with FL after a successful induction therapy in both first-line treatment and relapse. Consolidation with radioimmunotherapy is an innovative treatment approach to increase rates of complete remission and duration of remission. Here we summarize the data from actual trials and the resulting treatment indications.