In a nutshell
This article reviewed the outcomes and side effects associated with maintenance therapies for diffuse large B-cell lymphoma and mantle cell lymphoma.
Some background
After initial treatment, patients with diffuse large B-cell lymphoma (DLBCL) may have disease progression within 1 to 2 years. Patients with mantle cell lymphoma (MCL) may experience relapse after several years.
Maintenance therapy is one possible option to improve the outcomes of these patients. This is low-intensity therapy given over an extended period of time. The goal of this therapy is to delay relapse rather than cure the cancer.
Methods & findings
This review analyzed maintenance therapies for DLBCL and MCL.
In one study, 415 elderly patients with DLBCL received chemotherapy before maintenance therapy with rituximab (Rituxan). CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) was associated with a 55% improvement in survival without disease progression compared to the R-CHOP group (CHOP plus rituximab).
In another study, 650 elderly patients with DLBCL were treated with lenalidomide (Revlimid) or placebo (substance with no active effect). Average 2-year progression-free survival (patients alive without a return of disease) was significantly longer in the lenalidomide group (80%) than placebo (75%).
Rituximab maintenance has also been investigated for MCL. In one study, 47 patients with relapsed or refractory (does not respond to treatment) disease received rituximab or observation only. More patients in the rituximab group had remissions longer than 2 years. In another study, 274 elderly patients received R-CHOP or R-FC (rituximab, fludarabine, cyclophosphamide) before maintenance therapy. Four-year overall survival was significantly higher in the R-CHOP group (87%) than the R-FC group (63%).
Overall, rituximab was associated with increased risk of infections compared to observation or placebo. These included mild to moderate (24 – 27%) as well as severe infections (1 – 5%). Lenalidomide was associated with severe to life threatening low white blood cell count (23 – 57%) and low platelet count (cells involved in blood clotting; 3 – 4%). 28 – 61% of patients stopped therapy early.
The bottom line
This article reviewed the outcomes and side effects associated with rituximab and lenalidomide maintenance therapy for DLBCL and MCL.
Published By :
Current treatment options in oncology
Date :
Jul 21, 2018
