Rituximab Maintenance Can Delay Chemotherapy in Patients with Follicular Lymphoma

Craig Deligdish, MD

February 2011, Vol 2, No 1 - Meeting Highlights

Kirit M. Ardeshna, MDOrlando, FL—A study designed to compare 2 years of rituximab (Rituxan) therapy versus watchful waiting in patients with asymptomatic, advanced stage follicular lymphoma showed that maintenance therapy delayed the need for chemotherapy and other therapies by up to 3 years. This study was presented by Kirit M. Ardeshna, MD, of University College London Hospitals, United Kingdom.

Adult patients were randomized to either watchful waiting (n = 186), rituximab 375 mg/m2 weekly for 4 weeks, or ri tuximab 375 mg/m2 weekly for 4 weeks (n = 84), followed by rituximab maintenance every 2 months for 2 years (n = 192). As the benefit of rituximab maintenance became clear over the course of the study, the arm receiving 4 weeks of rituximab was halted.

A total of 462 pa tients were randomized to the 3 arms between September 2004 and May 2009.

At 3 years, 48% of patients in the watch-and-wait group had not initiated any new therapy; for those on short-term rituximab, 80% had not begun any new therapy; and for those on ri tuximab maintenance, the percentage therapy-free was 91%. Threeyear progression-free survival rates were similarly arrayed—33% in the watchful waiting group; 60% in those receiving 4 weeks of rituximab; and 81% for those on rituximab maintenance. How ever, there was no difference in overall survival, and 95% of patients remain alive at 3 years.

Regarding the effect of rituximab on overall survival, Dr Ardeshna indicated that further work needs to be done in assessing the impact of prior rituximab on response to first new treatment, response duration of this therapy, and time to second new treatment. In addition, although the study was designed to evaluate quality of life, Dr Ardeshna did not pre sent data on this outcome at 2010 ASH.

“Our study has shown that we can defer chemotherapy by a long time in patients who have asymptomatic follicular lymphoma,” Dr Ardeshna commented. “I imagine this will become the standard of care.”