Abstract
Induction with rituximab-based immunochemotherapy has considerably improved survival outcomes in patients with poor prognosis follicular lymphoma (FL) in both the first-line and relapsed/refractory disease settings. 1 Sousou T Friedberg J Rituximab in indolent lymphomas. Semin Hematol. 2010; 47: 133-142 Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar However, FL remains incurable and approaches to improve response duration and prolong survival have included evaluation of strategies using rituximab (R-maintenance). In the relapsed/refractory setting, a number of studies have investigated different R-maintenance schedules following various chemotherapy or rituximab-based immunochemotherapy induction strategies. 2 Forstpointner R Unterhalt M Dreyling M et al. Maintenance therapy with rituximab leads to a significant prolongation of response duration after salvage therapy with a combination of rituximab, fludarabine, cyclophosphamide, and mitoxantrone (R-FCM) in patients with recurring and refractory follicular and mantle cell lymphomas: Results of a prospective randomized study of the German Low Grade Lymphoma Study Group (GLSG). Blood. 2006; 108: 4003-4008 Crossref PubMed Scopus (420) Google Scholar , 3 Van Oers MH Van Glabbeke M Giurgea L et al. Rituximab maintenance treatment of relapsed/resistant follicular non-Hodgkin's lymphoma: long-term outcome of the EORTC 20981 phase III randomized intergroup study. J Clin Oncol. 2010; 28: 2853-2858 Crossref PubMed Scopus (267) Google Scholar , 4 Pettengell R Schmitz N Gisselbrecht C et al. Randomized study of rituximab in patients with relapsed or resistant follicular lymphoma prior to high-dose therapy as in vivo purging and to maintain remission following high-dose therapy. J Clin Oncol. 2010; 28 (abstract 8005).: 574s Google Scholar , 5 Landgren O Dunleavy K Wilson WH Re: Rituximab maintenance for the treatment of patients with follicular lymphoma: systematic review and meta-analysis of randomized trials. J Natl Cancer Inst. 2009; 101 (author reply 89–90.): 1287-1288 Crossref PubMed Scopus (4) Google Scholar Several of these trials have reported prolonged median progression-free survival (PFS) compared to observation. However, the study by Van Oers et al failed to show an overall survival (OS) benefit, and the conclusions drawn from a meta-analysis that indicated R-maintenance to yield improved OS have been viewed with caution. 3 Van Oers MH Van Glabbeke M Giurgea L et al. Rituximab maintenance treatment of relapsed/resistant follicular non-Hodgkin's lymphoma: long-term outcome of the EORTC 20981 phase III randomized intergroup study. J Clin Oncol. 2010; 28: 2853-2858 Crossref PubMed Scopus (267) Google Scholar , 6 Vidal L Gafter-Gvili A Leibovici L et al. Rituximab maintenance for the treatment of patients with follicular lymphoma: systematic review and meta-analysis of randomized trials. J Natl Cancer Inst. 2009; 101: 248-255 Crossref PubMed Scopus (145) Google Scholar
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