Rituximab as Maintenance Therapy for Patients with Follicular Lymphoma

Follicular lymphomas (FL) are a subgroup of B‐cell non‐Hodgkin lymphoma that account for 15%‐30% of newly diagnosed lymphomas. Follicular is an indolent lymphoma characterised by slow growth, high initial response rate but relapsing and progressive disease. Most patients present with advanced disease, i.e., stage III/IV, and cannot be cured with currently available therapy. The initiating genetic event found in 70%‐90% of patients with FL is the t(14;18), causing over‐expression of the anti‐apoptotic BCL‐2 protein (Cleary 1985). Clinical trials demonstrated an association between absence of the BCL‐2 rearrangement following therapy and reduced risk for reoccurrence (Corradini 2004; Lopez‐Guillermo 2000; Rambaldi 2002).

New treatment modalities are therefore being sought. The chimeric monoclonal antibody, rituximab, targeted against CD20 is expected to be active in many B cell lymphomas as those cells express CD20. Rituximab, administered intravenously, in combination with chemotherapy was demonstrated to improve overall survival compared to chemotherapy alone for patients with newly diagnosed and relapsed indolent lymphoma. (Schulz 2005) The value of rituximab as maintenance therapy for patients who responded to induction therapy is yet to be determined. Non‐comparative series suggest that rituximab may improve response rates (Hainsworth 2002; Gordan 2005). Although clinical trials have demonstrated that rituximab maintenance treatment may prolong complete remission and progression free survival clear evidence of improvement in overall survival is lacking (Ghielmini 2004). In practice rituximab maintenance therapy is not recommended in current guidelines (http://www.nccn.org/professionals/physician_gls/f_guidelines.asp)

To date, there are limited data from randomised clinical trials available to guide the use of rituximab as maintenance therapy in this patient population and few long‐term results. We will perform a systematic review and meta‐analysis of the literature to evaluate the long‐term effects and overall survival in particular of rituximab maintenance treatment in patients with FL.

The objectives are as follows: To evaluate the efficacy of rituximab maintenance therapy for patients with follicular lymphoma