Maintenance therapy with a targeting agent may provide survival benefits beyond first- and second-line chemotherapy in patients with diffuse large B-cell lymphoma, according to an analysis published in PLOS One (published online March 29, 2017; doi:10.1371/journal.pone.0174648).
The addition of CD20-targeting rituximab to standard chemotherapy, especially as a maintenance therapy, has shown to prevent relapse and improve survival outcomes for patients with follicular or mantle cell lymphoma. However, the effects of rituximab maintenance therapy in patients with diffuse large B-cell lymphoma – the most common type of non-Hodgkin lymphoma – remains largely unclear.
Juan Li, department of hematology, The Affiliated Drum Tower Hospital, Nanjing University Medical School (China), and colleagues conducted a meta-analysis to evaluate the effects of rituximab maintenance treatment of patients with diffuse large B-cell lymphoma. Data for a total of 1740 patients from 5 randomized controlled trials were eligible for the assessment. Hazard ratios (HRs) for time-to-event data and relative risks (RRs) for other data were recorded.
Results of the meta-analysis showed that patients who received rituximab maintenance therapy demonstrated significantly improved event-free survival (EFS) (HR = 0.80, 95% CI, 0.65-0.98) and progression-free survival (PFS) (HR = 0.72, 95% CI, 0.54-0.94) compared with patients who did not receive rituximab as maintenance. However, no significant difference in overall survival between the two groups was reported.
An analysis of a subgroup further showed that male patients may benefit from rituximab maintenance therapy. EFS for male patients with rituximab maintenance therapy (HR = 0.53, 95% CI, 0.34-0.82) outperformed EFS for female patients (HR = 0.99, 95% CI, 0.64-1.52).
Researchers concluded that rituximab maintenance treatment may offer survival benefits for patients – especially male patients – with diffuse large B-cell lymphoma who do not respond well to first- and second-line chemotherapy.
Authors of the study acknowledged adverse events associated with rituximab maintenance therapy, mainly grade 3 or 4 leukopenia and infection. “There was a slight tendency for patients in the rituximab maintenance arm to have more adverse events than patients in the observation arm (leukopenia: RR = 0.94, 95% CI: 0.92–0.97; infection: RR = 0.93, 95% CI: 0.90–0.96),” they wrote.
Authors recommend that patients considering rituximab maintenance therapy consider both survival benefits and adverse events before making a decision. – Zachary Bessette
