Impact of rituximab maintenance and maintenance schedule on prognosis in first-line treatment of follicular lymphoma. Retrospective analysis from Czech Lymphoma Study Group (CLSG) database

Abstract

Rituximab maintenance (RM) improves time to progression (PFS) in advanced follicular lymphoma (FL), but the impact of various RM schedules remains unknown. This study performed a retrospective evaluation of RM given for up to 2 years vs observation in 319 untreated FL patients (stage II-IV; grade 1-3A) responding to RCHOP induction and a comparison of two different RM schedules (RM8=eight doses given every 3 months and RM12=12 doses given every 2 months). A total of 183 patients received RM and 136 patients were observed; 5-year PFS was better in the RM arm, 74.1% vs 52.3% (p<0.001), which was projected in 5-year OS 93.8% vs 87.5% (p=0.005). However, 5-year PFS was similar in both the RM8 (n=54) and RM12 (n=56) arms. In the first line, RM significantly prolongs PFS and OS in FL, but different RM schedules bring a similar benefit.

Rituximab maintenance improves overall survival in follicular lymphoma: A retrospective nationwide real‐world analysis from Taiwan Cancer Registry Database

“…Although we do not enroll patients with stage I FL, we hypothesize that the survival benefit might be diminished when we include more patients with early‐stage diseases. The retrospective Czech study only includes patients receiving R‐CHOP as induction and uses PFS instead of TTF 15. In our subgroup analysis, patients receiving R‐CHOP as induction chemotherapies also tend to benefit from rituximab maintenance, but it is not statistically significant (Figure 3E, P ‐value .1048).…”

“…The first study utilizing data from National LymphoCare Study in the United States prospectively demonstrates that rituximab maintenance improves PFS (HR, 0.68; 95% CI, 0.56‐0.84) and TTF (HR, 0.66; 95% CI, 0.52‐0.84) instead of OS (HR, 0.81; 95% CI, 0.58‐1.14) 19. The other study retrospectively analyses data from the Czech Lymphoma Study Group (CLSG) database and shows that rituximab maintenance significantly prolongs PFS and OS (5‐year PFS, 74.1% in R‐maintenance vs 52.3% in observation, P ‐value <.001; 5‐year OS, 93.8% in R‐maintenance vs 87.5% in observation, P ‐value .005) 15. The conflicting results might be originated from the differences in patient selections and the definitions of survivals.…”

“…Rituximab combined with cytotoxic chemotherapies is superior to chemotherapies alone, regardless of frontline treatments or in relapse and/or refractory FL 8, 9, 10, 12, 13, 14, 15. Several prospective trials tried to address the clinical benefits of rituximab maintenance in the patients with FL, but rituximab maintenance only improves progression‐free survival instead of overall survival 16, 17, 18, 19.…”

“…Currently, no prospective randomized study has demonstrated the overall survival benefit of rituximab maintenance in the patients with FL. Only one meta‐analysis and one retrospective analysis showed the overall survival benefit of rituximab maintenance, and the most of included patients lived in the Western countries 15, 20. For Asian FL patients, only one phase II single‐arm Japanese study demonstrated the safety of rituximab maintenance in indolent BCL with high tumor burden 21.…”

Real world data on rituximab maintenance therapy after frontline immunochemotherapy in grade 1–3a follicular lymphoma

“…Whether more strict adherence to the treatment protocol from the PRIMA trial would have benefited our patients is unknown. However, PFS was similar for patients receiving eight versus 12 doses of rituximab maintenance in a recent retrospective study (Janikova et al, 2016).…”