Maintenance Therapy in Diffuse Large B Cell Lymphoma and Mantle Cell Lymphoma

Maintenance therapy has evolved as a strategy to prolong remissions in patients with diffuse large B cell lymphoma (DLBCL) or mantle cell lymphoma (MCL), typically following a more intensive therapy, such as induction therapy or stem cell transplantation. In randomized, controlled clinical trials, this approach has successfully prolonged overall survival in some MCL clinical settings, including after autologous stem cell transplantation and after R-CHOP induction, but has generally been unsuccessful in DLBCL. This most likely reflects differences in the biology and natural history of each disease. In DLBCL, a majority of patients are cured with frontline therapy, leaving fewer who can potentially benefit from maintenance. When the disease relapses, it is usually within the first 2 years and is usually clinically aggressive and difficult to control with low-intensity therapy. In contrast, nearly all patients with MCL will eventually relapse, and the disease may remain quiescent for many years. There may also be differences in sensitivity of minimal residual disease to maintenance treatments. Thus, future strategies to improve DLBCL treatments should focus on improved induction and possibly consolidation regimens rather than maintenance. In MCL, maintenance therapy will continue to play a role in the near future, although in both diseases, applying novel immunotherapies with the potential to eradicate residual disease clones persisting after induction may be the most successful strategy to improve patient outcomes.