Immunotherapy for the first-line treatment of B-cell non-hodgkin lymphoma

Recent studies have investigated the role of immunotherapy and other chemotherapy alternatives in various settings in the treatment of lymphoma, including as initial treatment in aggressive lymphoma and as components of combination therapy for relapsed and refractory disease. Radioimmunotherapy is being evaluated as both induction therapy and as consolidation after first-line induction therapy in patients with indolent non-Hodgkin lymphoma (NHL). Various treatments are also being evaluated in the maintenance setting to prolong response duration of therapy. Whereas maintenance rituximab has demonstrated a clear benefit in indolent lymphoma, rituximab maintenance has not demonstrated a significant benefit in patients with aggressive lymphoma. Newer strategies, including small-molecule inhibitors and immunomodulatory agents, are being assessed in the maintenance setting based on promising activity demonstrated in patients with relapsed/ refractory disease. Investigations into the molecular characteristics of NHL are revealing lymphoma subtypes with different gene expression patterns and different responses to therapy. Further investigations into these biomarkers may lead to the development of individualized therapy to optimize outcomes. In this monograph, leading lymphoma experts Drs. Martin H. Dreyling, Myron S. Czuczman, Peter McLaughlin, and Thomas E. Witzig provide insights based on recent and ongoing clinical research.