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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.
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.
Mantle 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.
Diffuse 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.
Hodgkin 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.
The 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.
Backbone ribbon from PDB 6VJA. RCSB PDB 6VJA. The ribbon widens where the chain is folded into a regular pattern and narrows where it is a loose loop.
Showing the molecule this term concerns: Rituximab.
The number to give a patient deciding about maintenance: a median of six and a half extra years before the next treatment, and no difference in how long they live. Both halves belong in the conversation.
A clean example of a progression-free survival benefit that did not become a survival benefit. Lenalidomide maintenance did not become standard practice after this trial, and the figures are the reason.
The trial that made two years of rituximab maintenance a routine offer after first-line immunochemotherapy for follicular lymphoma with a high tumour burden.
Shares 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, REMARC, Lenalidomide maintenance compared with placebo in responding elderly patients with diffuse large B-cell lymphoma treated with first-line R-CHOP, Sustained progression-free survival benefit of rituximab maintenance in patients with follicular lymphoma: long-term results of the PRIMA study.
Shares PRIMA, Fixed-duration, chemotherapy-free first-line treatment for the indolent lymphomas, Lenalidomide, Rituximab.
Shares 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, REMARC, Lenalidomide maintenance compared with placebo in responding elderly patients with diffuse large B-cell lymphoma treated with first-line R-CHOP, Sustained progression-free survival benefit of rituximab maintenance in patients with follicular lymphoma: long-term results of the PRIMA study.
Shares SHINE, Fixed-duration, chemotherapy-free first-line treatment for the indolent lymphomas, Maintenance therapy, Rituximab.
Shares Rituximab, Mantle cell lymphoma, Follicular lymphoma, Hodgkin lymphoma.
Shares SHINE, Fixed-duration, chemotherapy-free first-line treatment for the indolent lymphomas, Maintenance therapy, Rituximab.
Shares Lymphoma treatments that did not work: the negative trials worth knowing, PRIMA, Rituximab, Follicular lymphoma.
Shares Brentuximab vedotin, Lenalidomide, Rituximab, Diffuse large B-cell lymphoma.