Evaluating outcomes for patients with follicular lymphoma after prolonged rituximab maintenance therapy

This study investigated different rituximab schedules in patients with follicular lymphoma (FL) and reported their long-term treatment outcomes. The data showed that rituximab treatment alone on a standard schedule improves the long-term outcomes of these patients.

Follicular lymphoma (FL) is a type of non-Hodgkin lymphoma (NHL). It affects white blood cells called B-lymphocytes. These cells normally fight infection in the body. It is a common slow-growing cancer. FL that has relapsed (worsening of the disease) or refractory (not responded to the treatment) are more difficult to treat.

Rituximab (Rituxan) is commonly used in the treatment of FL. Rituximab is a monoclonal antibody, which works by helping the body’s immune system attack cancer cells. Maintenance therapy is long-term treatment with an anti-cancer drug at a lower dose. This can help prevent relapse. The optimal duration and long-term outcomes of rituximab maintenance therapy for patients with FL are still not known.

This study involved 270 patients with previously untreated, relapsed/refractory FL. All patients received 4 weekly doses of rituximab treatment alone. 165 patients responded to treatment and were randomly assigned to short-term or long-term maintenance therapy. 82 patients in the short-term group received 4 additional rituximab doses (375 mg/m²) every 2 months. 83 patients in the long-term group received a rituximab dose (375 mg/m²) every 2 months for up to 5 years. The average follow-up time was 10 years.

The average survival rate free of any FL-related events was 3.4 years in the short-term group compared to 5.3 years in the long-term group. The average survival without any cancer progression was 3.5 years in the short-term group and 7.4 years in the long-term group. However, these differences between groups were not statistically significant.

78% of all patients were alive after 10 years. In the short-term group, 78% were alive after 10 years, while in the long-term group, 79% were alive after 10 years. 

One-third of patients with advanced FL responding to frontline rituximab alone treatment required no further therapy and had a 10-year survival of more than 80% in both groups.

The rate of second cancers was similar in the 2 groups (9 patients after short-term maintenance and 10 patients after long-term maintenance). 

This study concluded that standard treatment with rituximab alone provided long-term survival for patients with FL, while long-term maintenance did not lead to any significant improvement in the outcomes of these patients.

This study had a small number of patients. This might have affected the results. The information regarding further therapies after progression/relapse was not collected. Also, the information about what proportion of patients showing histological transformation into a more aggressive lymphoma was missing.