Maintenance therapy in follicular lymphoma

This article reviews the potential benefit of maintenance therapy for patients with follicular lymphoma.

Follicular lymphoma, despite substantial improvements in survival, is usually incurable. Several randomized studies have shown that the combination of anti-CD20 and chemotherapy can improve overall survival for these patients. Recently, the old concept of maintenance treatment developed for acute leukemias was reintroduced in the treatment of indolent lymphomas. On the basis of its favorable toxicity profile, single agent rituximab remains a valuable option when given in a prolonged schedule to obtain durable remissions.

A first remission is easily obtained but relapses appear unavoidable. Patients achieving a partial response have poorer outcomes compared with those achieving complete remission. Furthermore, it has been demonstrated that among patients with follicular lymphoma who reach complete remission, those obtaining negative minimal residual disease, as assessed by molecular biology, have a better outcome compared with those remaining with residual disease. There is, therefore, a rationale to give additional treatment in an attempt to eradicate or to control the lymphoma cells responsible for relapse. An ideal maintenance regimen would have limited toxicity and should be easy to administer. Results of the International Primary Rituximab and Maintenance study show that 2 years of rituximab maintenance prolongs progression free survival, delays the time to next antilymphoma treatment and improves the quality of response in patients with previously untreated follicular lymphoma. Rituximab maintenance was well tolerated with a limited number of adverse events.