A 74-Year-Old Man With Relapsed/Refractory Follicular Lymphoma - Episode 3
Kami Maddocks, MD, explains the factors surrounding when and why a physician may choose to introduce maintenance therapy for a patient with follicular lymphoma.
Kami Maddocks, MD: Maintenance therapy in follicular lymphoma [FL] has been studied after combination chemoimmunotherapy with R [rituximab]-CHOP [cyclophosphamide, doxorubicin hydrochloride (hydroxydaunorubicin), vincristine sulfate (oncovin), and prednisone] and with R-CVP [rituximab, cyclophosphamide, vincristine sulfate, prednisone] and maintenance rituximab was shown to prolong progression-free survival [PFS], although not overall survival [OS] after this treatment. When you look at it with bendamustine based therapy, it’s not specifically been studied on its own BR compared with BR with rituximab maintenance, although we do know that studies have shown retrospectively reviewing that patients with BR that achieve a complete remission by PET [positron emission tomography] scan, do not seem to benefit from maintenance therapy, but though they achieve a PR to treatment with BR, do seem to benefit from rituximab maintenance.
In patients where you use obinutuzumab based therapy, this has only been studied with maintenance therapy and so it is recommended, although we know when the trial was evaluated, bendamustine plus or minus rituximab versus obinutuzumab, that there was increased cytopenias and increased infections reported in the study, which is felt to potentially be based on the benda [bendamustine] induction therapy, but also brings into question if maintenance after bendamustine can lead to an increased risk of infections.
In my practice, I don’t usually use rituximab maintenance, especially because I use bendamustine as my first-line treatment in most patients. There is more data again to support its use of R-CHOP based therapy, although this is all in prolonging PFS and not OS.
Transcript edited for clarity.
Case: A 74-Year-Old Man With Relapsed/Refractory Follicular Lymphoma