{"entity":{"id":"lymphoma-tx-maintenance","kind":"term","name":"Maintenance and consolidation in lymphoma: where it works and where it does not","aka":["Rituximab maintenance","Lenalidomide maintenance","Brentuximab consolidation"],"tldr":"After the main treatment, some lymphomas are given a lower-intensity drug for months or years to hold the remission. It lengthens remission in follicular and mantle cell lymphoma but has never been shown to lengthen life, so it is a trade against two years of infusions and infections.","summary":"Follicular lymphoma. PRIMA randomised 1,018 responders after first-line immunochemotherapy to two years of rituximab every eight weeks or observation. At the final analysis, median progression-free survival was 10.5 years with maintenance against 4.1 years with observation (hazard ratio 0.61), but ten-year overall survival was about 80 per cent in both arms. Maintenance therefore buys time to the next treatment and costs two years of infusions, neutropenia and a higher infection rate. Many units now discuss it as a choice.\n\nMantle cell lymphoma. LyMa randomised 240 patients under 66 after autologous transplant to three years of rituximab every two months or observation: four-year event-free survival 79 against 61 per cent, and, unusually for maintenance, overall survival was improved. Rituximab maintenance after transplant is standard in Europe and the United Kingdom.\n\nDiffuse large B-cell lymphoma. Maintenance has repeatedly failed to change survival. REMARC gave lenalidomide or placebo for two years to 650 responders aged 60 to 80 after R-CHOP: progression-free survival improved (hazard ratio 0.708) but overall survival did not (hazard ratio 1.218), and grade 3 or 4 neutropenia was 56 against 22 per cent. Rituximab maintenance after R-CHOP has never shown benefit.\n\nHodgkin lymphoma. AETHERA gave brentuximab vedotin or placebo after autologous transplant to 329 patients at high risk of relapse and improved progression-free survival (median 42.9 against 24.1 months, hazard ratio 0.57); this is consolidation of a transplant rather than open-ended maintenance, and it is standard for the high-risk group.\n\nThe honest summary: maintenance treats the scan, not always the person. It is the right choice for someone who values a longer interval before the next line, and the wrong one for someone who wants to stop treatment and be well.","asOf":"2026-09-29","links":[{"label":"PRIMA: two years of rituximab maintenance in follicular lymphoma, Lancet 2011","url":"https://doi.org/10.1016/S0140-6736(10)62175-7"},{"label":"PRIMA final analysis at nine years, Journal of Clinical Oncology 2019","url":"https://doi.org/10.1200/JCO.19.01073"},{"label":"LyMa: rituximab after autologous transplant in mantle cell lymphoma, New England Journal of Medicine 2017","url":"https://doi.org/10.1056/NEJMoa1701769"},{"label":"REMARC: lenalidomide maintenance after R-CHOP, Journal of Clinical Oncology 2017","url":"https://doi.org/10.1200/JCO.2017.72.6984"}],"tags":[],"related":[],"cancers":["follicular-lymphoma","mantle-cell-lymphoma","dlbcl","hodgkin-lymphoma","non-hodgkin-lymphoma"],"sections":[],"technologies":[],"targets":[],"drugs":["rituximab","lenalidomide","brentuximab-vedotin"],"companies":[],"institutions":[],"pathways":[],"terms":["maintenance-therapy","consolidation-therapy"],"trials":["aethera"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"category":"Treatment jargon"},"route":"/terms/lymphoma-tx-maintenance/","neighbours":{"cancer":[{"id":"dlbcl","kind":"cancer","name":"Diffuse large B-cell lymphoma","route":"/cancers/dlbcl/"},{"id":"follicular-lymphoma","kind":"cancer","name":"Follicular lymphoma","route":"/cancers/follicular-lymphoma/"},{"id":"hodgkin-lymphoma","kind":"cancer","name":"Hodgkin lymphoma","route":"/cancers/hodgkin-lymphoma/"},{"id":"mantle-cell-lymphoma","kind":"cancer","name":"Mantle cell lymphoma","route":"/cancers/mantle-cell-lymphoma/"},{"id":"non-hodgkin-lymphoma","kind":"cancer","name":"Non-Hodgkin lymphoma (all types)","route":"/cancers/non-hodgkin-lymphoma/"}],"drug":[{"id":"brentuximab-vedotin","kind":"drug","name":"Brentuximab vedotin","route":"/drugs/brentuximab-vedotin/"},{"id":"lenalidomide","kind":"drug","name":"Lenalidomide","route":"/drugs/lenalidomide/"},{"id":"rituximab","kind":"drug","name":"Rituximab","route":"/drugs/rituximab/"}],"term":[{"id":"consolidation-therapy","kind":"term","name":"Consolidation therapy","route":"/terms/consolidation-therapy/"},{"id":"lymphoma-tx-failed-and-negative","kind":"term","name":"Lymphoma treatments that did not work: the negative trials worth knowing","route":"/terms/lymphoma-tx-failed-and-negative/"},{"id":"maintenance-therapy","kind":"term","name":"Maintenance therapy","route":"/terms/maintenance-therapy/"},{"id":"lymphoma-tx-regimen-alphabet","kind":"term","name":"The lymphoma regimen alphabet: R-CHOP, pola-R-CHP, DA-EPOCH-R, ABVD, BEACOPP and the rest","route":"/terms/lymphoma-tx-regimen-alphabet/"}],"trial":[{"id":"aethera","kind":"trial","name":"AETHERA","route":"/trials/aethera/"},{"id":"lyma","kind":"trial","name":"LyMa","route":"/trials/lyma/"},{"id":"prima-follicular","kind":"trial","name":"PRIMA","route":"/trials/prima-follicular/"},{"id":"remarc","kind":"trial","name":"REMARC","route":"/trials/remarc/"},{"id":"shine","kind":"trial","name":"SHINE","route":"/trials/shine/"}],"paper":[{"id":"paper-remarc-lenalidomide-maintenance-dlbcl-jco-2017","kind":"paper","name":"Lenalidomide maintenance compared with placebo in responding elderly patients with diffuse large B-cell lymphoma treated with first-line R-CHOP","route":"/key-papers/paper-remarc-lenalidomide-maintenance-dlbcl-jco-2017/"},{"id":"paper-prima-rituximab-maintenance-follicular-lancet-2011","kind":"paper","name":"Rituximab maintenance for 2 years in patients with high tumour burden follicular lymphoma responding to rituximab plus chemotherapy (PRIMA): a phase 3, randomised controlled trial","route":"/key-papers/paper-prima-rituximab-maintenance-follicular-lancet-2011/"},{"id":"paper-prima-final-rituximab-maintenance-follicular-jco-2019","kind":"paper","name":"Sustained progression-free survival benefit of rituximab maintenance in patients with follicular lymphoma: long-term results of the PRIMA study","route":"/key-papers/paper-prima-final-rituximab-maintenance-follicular-jco-2019/"}],"idea":[{"id":"lymphoma-ev-fixed-duration-chemotherapy-free-first-line","kind":"idea","name":"Fixed-duration, chemotherapy-free first-line treatment for the indolent lymphomas","route":"/ideas/lymphoma-ev-fixed-duration-chemotherapy-free-first-line/"}]}}