Maintenance therapy

The authors' conclusion is that ibrutinib-rituximab should be considered a new standard-of-care option for first-line treatment of older patients with mantle-cell lymphoma. The subgroup split means it is clearly better than R-CHOP and roughly equivalent to bendamustine-rituximab.

Twenty-eight extra months of progression-free survival, with no survival gain and a high rate of severe adverse events in both arms. It set up the two trials that followed: ECHO, which substituted a more selective inhibitor, and ENRICH, which removed the chemotherapy.

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.

One of the few maintenance strategies in lymphoma that improved overall survival rather than only progression-free survival, and the reason three years of rituximab became standard after autologous transplantation in mantle cell lymphoma.

The trial that made two years of rituximab maintenance a routine offer after first-line immunochemotherapy for follicular lymphoma with a high tumour burden.