How do you approach maintenance therapy for relapsed follicular lymphoma?

Specifically, do you consider repeating maintenance therapy after second line therapy if a patient had already received 2 years of maintenance rituximab with frontline therapy? Does it matter if the relapse is > 12 months or < 12 months after frontline therapy?

1 Answer

Mednet Member

Medical Oncology · Mayo Clinic College of Medicine and Science (Scottsdale)

Answered on · Updated on

In general, patients who received 2 years of maintenance rituximab in first-line settings are unlikely to benefit from more maintenance rituximab in second-line. This is especially true if relapse occurs within 24 months of first-line therapy.

A meta-analysis (JNCI 2011) did show a small benefit in overall survival with maintenance rituximab with a higher rate of toxicity in second-line setting, but this benefit seemed to be driven by the EORTC 20981 trial comparing CHOP to R-CHOP followed by a second randomization of maintenance vs no maintenance. Although not significant, there was a trend towards improvement in OS in that trial. This was also seen in the SAKK 35/98, but again, these are patients who did not receive rituximab in the front-...

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