Treatment of indolent lymphoma without chemotherapy: hype or hope?

Background. Since the 1960s cytostatic drugs have been essential in the treatment and control of indolent lymphoma. Objective. In the last few decades new therapeutic principles were introduced and their importance needs to be classified compared to classical chemotherapy. Results. Monoclonal antibodies, such as the CD20 antibody rituximab, are an established component in the treatment of follicular lymphoma. A monotherapy with rituximab is a possible option in older patients but has not officially been approved. Novel CD20 antibodies, such as obinutuzumab can improve the progression-free survival in patients with follicular lymphoma. Since 2016, the PI3K inhibitor idelalisib has been approved for treatment of relapsed or refractory follicular lymphoma. New targeted therapies, such as the immunomodulator lenalidomide can enrich the therapeutic options, as the combination of rituximab and lenalidomide shows an effectiveness comparable to chemoimmunotherapy. Ibrutinib is approved for the treatment of relapsed or refractory Waldenstrom's macroglobulinemia. Conclusion. The CD20 antibodies and targeted drug treatment expand the therapeutic options; however, they cannot yet completely replace chemotherapy.