Should all patients with indolent lymphoma be treated with rituximab maintenance therapy? An overview of the data

Indolent non-Hodgkin's lymphoma remains a generally incurable malignancy. Administration of the anti-CD20 monoclonal antibody rituximab as a single agent or in combination with chemotherapy has become widely employed in this patient population. Although the addition of maintenance treatment after 1 course of single-agent rituximab prolongs time to progression in patients with indolent non-Hodgkin's lymphoma, a similar "duration of rituximab benefit" is observed when rituximab is administered at the time of relapse. Progression-free survival is clearly improved when rituximab is administered with chemotherapy whether it is given concomitantly, in a maintenance fashion, or both. In fact, the available data show a trend toward survival benefit with these strategies in some settings. Further follow-up will elucidate the effect of maintenance rituximab on long-term outcomes. For now, these initial data suggest that patients with indolent lymphoma might derive significant benefit from these novel therapeutic strategies.