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Posted by on Sep 6, 2018 in Non-Hodgkin lymphoma | 0 comments

In a nutshell

This study evaluated the effectiveness of rituximab (Rituxan) maintenance therapy in patients with newly diagnosed follicular lymphoma (FL). This study concluded that this therapy improves survival outcomes in these patients.

Some background

For patients with early (stage 1 – 2) FL, aggressive radiotherapy or chemoimmunotherapy are typical first-line (initial) treatments. For patients with advanced (stage 3 – 4) disease, chemotherapies with rituximab are recommended. After initial treatment, some patients may need maintenance therapy.

Maintenance therapy is a low-intensity therapy given for a long period of time after initial treatment. The goal of this therapy is to delay relapse (cancer recurrence). The impact of rituximab maintenance therapy on long-term survival in patients with FL remains under investigation.

Methods & findings

This study involved the medical records of 396 patients. Patients had stage 2 – 3 (55.3%) or stage 4 disease (44.7%). All patients previously received first-line chemotherapy containing rituximab. After this, patients received either rituximab maintenance therapy (65.7%) or observation only (34.3%). Patients were followed-up for an average of 2.6 years.

At follow-up, 31.9% (maintenance therapy) and 29.4% (observation only) of patients relapsed and started additional therapy. Most patients received either rituximab only or chemotherapy containing rituximab.

Three-year overall survival (patients still alive at 3 years) was significantly higher in the maintenance therapy group compared to the observation-only group (94.5% vs. 89.0%). Rituximab maintenance therapy was significantly associated with a 58% higher survival rate.

Certain factors were associated with an increased risk of poor overall survival. These included being age 60 or older (2.58-fold) and having stage 4 disease (2.47-fold). However, patients with these factors in the maintenance therapy group tended to have better survival than patients in the observation-only group.

89.2% (maintenance therapy) and 80.7% (observation only) of patients experienced treatment failure (stopped rituximab and started other therapies) after 1 year of treatment. At 2 years, this rate decreased to 69.0% (maintenance therapy) and 75.0% (observation only).

The bottom line

This study concluded that rituximab maintenance therapy improves survival outcomes in patients with newly diagnosed FL. The authors suggest that patients aged 60 or older or with stage 4 disease may benefit the most from this therapy.

The fine print

This study was retrospective, meaning it looked back in time to analyze data. This study involved Taiwanese patients, so the results may not be generalizable to all patients.

Rituximab maintenance therapy is only approved for 2 to 2.5 years by the National Health Insurance system in Taiwan. This is why many patients in this study stopped rituximab and switched to other therapies.

The authors of this study received funding from Roche Ltd., the manufacturer of rituximab in Taiwan.

Published By :

Cancer Medicine

Date :

Aug 01, 2018

Original Title :

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

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