Kelas : 3EB24
NPM : 29214956
Review Article 3
Pros and cons of rituximab maintenance in follicular lymphoma
Highlights
• MR delays progression of disease in FL, although its
cost/benefit ratio remains controversial.
• Favoring MR: Prolonged PFS, trend to OS benefit in
meta-analysis, without compromising QoL.
• Against MR: Lack of OS benefit in individual trials,
increase toxicity/cost, no improvement in QoL
Abstract
Follicular lymphoma (FL) is the most prevalent
indolent non-Hodgkin lymphoma. Most patients present with advanced disease and
are incurable with current therapy. The approval of rituximab has
revolutionized the treatment of follicular lymphoma when administered in the
induction setting for high-tumor burden disease, but the use of rituximab as a
maintenance therapy (MR) continues to be a point of controversy. In this
article, we review the main data and arguments in favor and against MR in FL.
In summary, most studies have demonstrated a significant benefit in
progression-free or event-free survival in this notoriously recurrent disease;
however, long-term outcomes could not consistently demonstrate to be improved
with this intervention. In a meta-analysis of randomized trials overall
survival (OS) showed a tendency to improvement when given to patients in
relapse, but no single study reached a significant OS advantage. The risk of
high-grade transformation does not seem to be reduced in prospective trials. On
the other hand, MR clearly increases toxicity without an improvement in quality
of life. Finally, MR is expensive, and it is not proven that the delayed
relapse time can compensate for these costs. In conclusion, despite the proven
increase in progression-free survival, MR can’t be recommended as a standard
for the treatment of FL.
Keywords
- Follicular lymphoma;
- Maintenance therapy;
- Rituximab
