Rituximab maintenance in relapsed or refractory follicular non-Hodgkin’s lymphoma: the evidence of its therapeutic value

INTRODUCTION: Non-Hodgkin’s lymphoma (NHL) is the sixth most common malignancy, and follicular lymphoma (FL) is the second most common form of NHL. FL is generally considered to be incurable, and is characterized by periods of remission followed by episodes of relapse, with median survival of 8–10 years. Maintenance treatment is aimed at improving quality of life and survival. AIMS: To review the current evidence for maintenance rituximab in patients with FL. EVIDENCE REVIEW: Two randomized studies of rituximab maintenance or observation after induction therapy with single-agent rituximab, which were performed mainly in patients with relapsed/refractory disease, have demonstrated a two- to three-fold improvement in median progression-free survival (PFS) in the maintenance arm. Two further studies of rituximab maintenance or observation following induction chemotherapy with or without rituximab performed in patients with relapsed/refractory FL have shown a two- to four-fold increase in median PFS in the maintenance arm. In one of these studies an overall survival benefit has also been demonstrated. An additional study, this time in previously untreated patients, has demonstrated a four-fold improvement in median PFS as well as a significant overall survival benefit with rituximab maintenance following induction with chemotherapy alone. PLACE IN THERAPY: Currently rituximab maintenance can be considered to be appropriate therapy for patients with relapsed/refractory disease who have not received rituximab previously and who are not suitable for autologous stem cell transplantation, and for patients who receive first-line therapy with chemotherapy without rituximab.