From the Journals

Meta-analysis supports rituximab maintenance in MCL



Patients with mantle cell lymphoma (MCL) have better outcomes if they receive rituximab (Rituxan) maintenance therapy after induction therapy, albeit with the trade-off of higher risk of neutropenia, according to results of a meta-analysis reported in HemaSphere.

Investigators led by Liat Vidal, MD, of Tel-Aviv University, analyzed data from six randomized controlled trials of maintenance therapy including 858 patients with MCL who had a complete or partial response to induction therapy. The maintenance therapy was rituximab in five trials and bortezomib (Velcade) in one trial. The median duration of follow-up was 26-59 months across trials.

Main results showed that, compared with patients who were simply observed or given maintenance interferon-alfa, those given maintenance rituximab had a significantly reduced risk of progression or death (pooled hazard ratio, 0.58; 95% confidence interval, 0.45-0.73) and a nonsignificantly reduced risk of death (pHR, 0.79; 95% CI, 0.58-1.06).

Rituximab maintenance therapy was associated with a doubling of the risk of grade 3 or 4 neutropenia (risk ratio, 2.02; 95% CI, 1.50-2.73). However, there was no significant difference between groups with respect to risks of infection, or grade 3 or 4 anemia or thrombocythemia.

None of the included trials reported on quality of life outcomes.

The lone trial of bortezomib maintenance did not find any significant event-free survival or overall survival benefit.

“Based on our results, rituximab maintenance is recommended after immunochemotherapy with R-CHOP or cytarabine-containing induction in the front-line setting for transplant-eligible and -ineligible patients, and after R-CHOP in the relapse setting. It is unclear if maintenance is of benefit after different induction chemotherapy such as bendamustine or fludarabine,” Dr. Vidal and coauthors conclude. “By contrast, current data does not support improved outcomes with bortezomib maintenance for MCL patients.”

Dr. Vidal disclosed that she is an employee of Syneos Health. The study received no funding.

SOURCE: Vidal L et al. HemaSphere. 2018 Aug;2(4):e136.

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