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Maintenance Rituximab Linked to Improved Outcomes in MCL

Angelica Welch
Published: Monday, Jul 16, 2018

Talal Hilal, MB, BCh

Talal Hilal, MB, BCh

In a meta-analysis of rituximab (Rituxan) maintenance for patients with mantle cell lymphoma (MCL), investigators concluded that this approach improves progression-free (PFS) and overall survival (OS) following induction chemoimmunotherapy.

, Hilal, an assistant professor of Medicine at Mayo Clinic, discussed the findings of this meta-analysis, and the approach to maintenance therapy in patients with MCL.

OncLive: Can you provide an overview of this trial?

Hilal: This was a meta-analysis where we aimed to answer the question of what the benefit of maintenance rituximab is in patients who have MCL. There are not many studies, so we thought that a systematic review would be a good way to start. We found about 700 studies that were screened by about 7 meta-inclusion criteria, which were pretty broad. They did not specify whether it was a first-line treatment, relapse, or posttransplant. The main thing was that they must have had induction chemoimmunotherapy. We also included randomized trials and observational studies with comparative arms. Randomized trials were included, and 4 observational studies were included.

We found that in the overall population, there was a benefit in terms of PFS and OS. In the prospective studies only, the benefit was mainly PFS, and there was no OS benefit. There are only 3 prospective trials, and 2 of them did not use transplant. That is the main driver of the OS benefit in terms of prospective studies. Retrospective studies have their own limitations—there is a lot of heterogeneity and differences in how patients were treated. When we looked at transplant only, there were a couple that were excluded because they did not do transplants, so we were left with about 5. In those studies, there was a benefit in PFS, but not OS.

What else needs to be understood about rituximab in this setting?

There was a study presented at the 2016 ASCO Annual Meeting, which was a subgroup of the [StiL NHL7-2008] MAINTAIN trial, which looked at bendamustine/rituximab induction followed by maintenance versus observation. That is not published yet as a paper; however, in that trial, there was no benefit in PFS or OS. Those are patients who did not receive a transplant and were not fit for transplant. They received the most common induction regimen that we use, which was not reflected in this meta-analysis. A lot of clinicians don't offer maintenance rituximab in the setting of no transplant. They'll receive chemoimmunotherapy and get a response, but then it is sort of unknown.
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