Is rituximab maintenance effective long-term for follicular lymphoma after an autologous stem cell transplant?

The authors reviewed rituximab (Rituxan) maintenance (RM) therapy in patients with relapsed follicular lymphoma (FL) treated with an autologous stem cell transplant (ASCT). The study found that RM after ASCT delayed FL relapse after a 12-year follow up.

Rituximab and chemotherapy have improved the outcomes of patients with FL. However, treatments after relapsed (return of the cancer) disease have limited effectiveness. High-dose chemotherapy combined with ASCT has improved relapsed FL patient outcomes. ASCT uses healthy blood stem cells from the patient's own body to replace cancerous cells destroyed by chemotherapy. ASCT is now considered a standard treatment for FL due to the lack of relapse noted in patients after 7-8 years.

Maintenance therapy is treatment given in patients who achieve remission to relay or prevent relapse. Rituximab maintenance (RM) after ASCT was seen as safe and prolonged survival without cancer worsening in patients with relapsed FL. However, the long-term outcomes of RM after ASCT in these patients is still unknown.

This study enrolled 203 patients with relapsed FL in complete or very good partial remission. After chemotherapy, patients were randomly assigned to a rituximab group and a control group before stem cells were collected. After ASCT, patients received RM every 2 months or no maintenance (NM). The high-dose chemotherapy used was BEAM (BCNU, etoposide, cytarabine, and melphalan). The average follow-up period was 12 years for all treatment groups.

The risk of relapse at 10 years was 50% lower in patients who got RM after ASCT compared to the NM group. Patients who received any rituximab were 40% more likely to have better survival without cancer worsening after 10 years. RM improved survival without cancer worsening chances by 45%.

This study showed that RM after ASCT improved the risk of relapse and survival without cancer worsening in patients with relapsed FL in the long-term.

This study included only patients who did not receive rituximab as first-line treatment. The results may not apply to patients who received rituximab as first-line treatment.