Patients with relapsed or refractory follicular lymphoma who continue on maintenance rituximab therapy after chemotherapy have better overall survival than patients who do not receive this treatment, according to a meta-analysis of randomized trials.
Most patients with follicular lymphoma respond to initial therapy but many experience disease relapse. Previous trials have showed that rituximab plus chemotherapy improves overall survival in these patients compared with chemotherapy alone. However, it has not been clear if continuing rituximab treatment beyond the completion of chemotherapy further prolongs overall survival.
To determine the impact of maintenance rituximab on overall survival, Liat Vidal, M.D., of the Rabin Medical Center in Petah-Tikva, Israel, and colleagues pooled data from five randomized trials that compared maintenance therapy with no maintenance therapy. Overall survival data were available for 985 patients.
Rituximab maintenance therapy was associated with a 40% improvement in overall survival relative to observation or retreatment with rituximab at relapse. The improvement in overall survival was statistically significant for patients with relapsed or refractory lymphoma, but not for previously untreated patients. Patients treated with rituximab maintenance therapy, however, had nearly twice the rate of infection-related adverse events as patients who did not have prolonged rituximab therapy.
"Our results suggest that rituximab maintenance therapy for up to 2 years, either as four weekly infusions every 6 months or as a single infusion every 2 – 3 months, should be added to standard therapy of patients with relapsed or refractory follicular lymphoma after successful induction treatment," the authors write. "The higher rate of infections with rituximab therapy should be taken into consideration when making treatment decisions."
- Vidal et al. Rituximab Maintenance for the Treatment of Patients With Follicular Lymphoma: Systematic Review and Meta-analysis of Randomized Trials. JNCI Journal of the National Cancer Institute, 2009; DOI: 10.1093/jnci/djn478
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