March 31, 2009

Maintenance Rituxan® Prolongs Survival in Advanced Indolent Lymphoma


Maintenance Rituxan® (rituximab) given after standard chemotherapy significantly prolongs progression-free survival (PFS) in patients with advanced-stage indolent non-Hodgkin’s lymphoma, according to the results of a study published in the Journal of Clinical Oncology.1 

Non-Hodgkin’s lymphoma (NHL) is a form of cancer that begins in the cells of the lymph system. It is characterized by excessive accumulation of cancerous lymphocytes, which can crowd the lymph system and suppress the formation and function of other immune and blood cells. Indolent, or low-grade, NHL refers to lymphoma that grows and spreads slowly and has few symptoms. Follicular lymphoma (FL) is a type of indolent NHL that affects the B-cells of the lymph system.

Treatment for indolent NHL often includes initial therapy, referred to as induction therapy, as well as continued therapy, referred to as maintenance therapy. Maintenance therapy is used for extended periods to provide continued suppression of the cancer. Rituxan is a targeted agent that binds to a specific component of B-cells, thereby enabling the immune system to “kill” those cancerous cells. Rituxan is becoming standard for use as maintenance therapy for indolent lymphoma, and researchers continue to evaluate its efficacy in this population.

The current study included 311 patients with Stage III-IV indolent NHL, 282 of whom had follicular lymphoma. All patients had responding or stable disease after receiving chemotherapy induction treatment with CVP: Cytoxanâ (cyclophosphamide), Oncovinâ (vincristine), and prednisone. The patients were randomly assigned to observation (153) or maintenance therapy with Rituxan (158). The maintenance Rituxan therapy began four weeks after completion of the last cycle of CVP and was delivered once per week for four weeks every six months for four courses.

The results indicated that the three-year PFS was 68% for the group of patients receiving the maintenance Rituxan and 33% for those assigned to observation. In the sub-group of patients with follicular lymphoma, the PFS for the maintenance group was 64% and 33% for the observation group. At three years, overall survival was 92% for the maintenance group and 86% for the observation group (among patients with follicular lymphoma: 91% for maintenance versus 86% for observation). Toxicity was minimal.

The researchers concluded that maintenance Rituxan “after chemotherapy significantly prolongs PFS [in patients with advanced-stage indolent NHL], to a far greater extent than achieved by any prior strategy and with minimal toxicity.” Research will likely be ongoing in this area.


1 Hochster H, Weller E, Gascoyne RD, et al. Maintenance rituximab after cyclophosphamide, vincristine, and prednisone prolongs progression-free survival in advanced indolent lymphoma: Results of the randomized phase III ECOG1496 Study. Journal of Clinical Oncology [online publication]. March 2, 2009, 10.1200/JCO.2008.17.1561

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Tags: Non-Hodgkin's Lymphoma, Uncategorized