Evolving therapy options for B-cell low grade lymphoma

Abstract

This article presents actual treatment opinions of low grade B-cell lymphomas. The precise diagnosis of lymphoma subtype is necessary for adequate treatment planning and identification of prognostic factors for adverse clinical outcome, as well as predictive factors for particular treatment response. Taking into consideration that low grade lymphomas constitute a heterogenic group of entities, the differences in clinical course have been described. The most adequate induction treatment for follicular lymphoma is chemoimmunotherapy with rituximab. The optimal chemotherapy schedule has not been established yet in clinical trials but their results are expected during the years to come. Independently of induction therapy, patients with follicular lymphoma beneficiate from maintenance treatment with rituximab. In splenic marginal zone lymphoma splenectomy remains the first line treatment of choice. In MALT lymphoma chemotherapy, especially based on purine analogs is efficient as well as immunotherapy in chosen patients but antibiotics need to be incorporated in first line therapy. Radiotherapy is a potential treatment option for only local involvement. In nodal marginal zone lymphoma, the same approach as in follicular lymphoma is advised. In lymphoplasmacytic lymphoma chemotherapy is efficient but in cases with blood orhyperviscosity plasmapheresis is advised, while patients with cryoglobulinemia beneficiate from rituximab or/and cyclophosphamide.