Would you offer rituximab maintenance for 2 years after a successful response to induction in a patient with splenic marginal zone lymphoma?

The answer will depend on age, performance status of the patient, thrombocytopenia, etc.

No difference in OS was noted but freedom from progression was noted in rituximab group. 1 year did as good as 2 years maintenance.

Kalpadakis et al., PMID 29914978

Rituxan maintenance especially when done for 2 years versus 1 year can cause thrombocytopenia.

Also, patients with thrombocytopenia and mzl tend to have lower freedom from progression at 5 years (50% vs 75%).

IF your patient did not respond to Rituxan and has persistent thrombocytopenia, splenectom...