Talal Hilal, MB, BCh, assistant professor of Medicine at Mayo Clinic, discusses the benefit of maintenance rituximab (Rituxan) in the treatment of patients with mantle cell lymphoma (MCL).

A subgroup analysis of the StiL NHL7-2008 MAINTAIN trial presented at the 2016 ASCO Annual Meeting looked at bendamustine/rituximab induction followed by maintenance therapy compared with observation. However, no benefit in progression-free survival or overall survival were observed with the maintenance therapy. Notably, these were patients who had not received a transplant or were unfit for transplant. Based off of these data, most physicians will not offer maintenance rituximab in this setting; instead, they’ll offer chemoimmunotherapy to patients.

Investigating rituximab maintenance with a more intensive chemotherapy regimen may prove useful in this setting, says Hilal. Additionally, using cytarabine induction in patients who are younger may be beneficial; this population may benefit from maintenance rituximab. As it stands, maintenance rituximab is advised for patients after transplant, whereas it remains investigational in those who have not undergone transplant, concludes Hilal.

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Dr. Hilal on the Benefit of Maintenance Rituximab in Patients With MCL

Talal Hilal, MB, BCh, assistant professor of medicine, Mayo Clinic, discusses a study of rituximab (Rituxan) maintenance in patients with mantle cell lymphoma (MCL) after induction chemoimmunotherapy.

In this meta-analysis, investigators aimed to determine the benefit of maintenance rituximab in the treatment of patients with MCL. Since there are not many studies of rituximab in this population, investigators decided to do a systematic review, Hilal explains. They collected 697 records and 28 full-text articles through PubMed, Embase, Scopus, Web of Science, and Cochrane, and assessed them for eligibility. Overall, 1,050 patients met the inclusion criteria, with 455 patients in the rituximab maintenance arm and 595 in the non-rituximab maintenance arm.

The study did not distinguish between patients were who treated in the first-line, at relapse, or post-transplant—patients were eligible as long as they had received induction chemoimmunotherapy. Randomized trials and observation studies with comparative arms were also included, Hilal says.

Talal Hilal, MB, BCh, assistant professor of medicine, Mayo Clinic, discusses a study of rituximab (Rituxan) maintenance in patients with mantle cell lymphoma (MCL) after induction chemoimmunotherapy.
 

Dr. Hilal Discusses Study of Rituximab Maintenance in MCL

Talal Hilal, MB, BCh, assistant professor of medicine, Mayo Clinic, discusses the meta-analysis of rituximab (Rituxan) maintenance for patients with mantle cell lymphoma.

In the overall population, there was a benefit in terms of progression-free survival (PFS) and overall survival (OS) in all of the studies. In the prospective studies, the benefit was mainly PFS—there was no OS benefit. Only 3 prospective trials were included in the analysis, and only 1 used transplant. That, says Hilal, is the main driver of OS benefit in these studies.

The retrospective studies have their own limitations, states Hilal. There was a lot of heterogeneity and differences in how patients were treated. In the transplant only group, there were a couple patients who were excluded because they did not undergo transplant. In those studies, there was a PFS benefit as well, but no OS benefit.

Therefore, patients who are young, fit, and eligible for transplant should be started with an induction chemoimmunotherapy that includes cytarabine-based regimens and rituximab maintenance. It is still a question as to whether this regimen is appropriate for older patients and patients who are not eligible for transplant, says Hilal.

Talal Hilal, MB, BCh, assistant professor of medicine, Mayo Clinic, discusses the meta-analysis of rituximab maintenance for patients with mantle cell lymphoma.

Talal Hilal, MB, BCh

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Dr. Hilal on the Benefit of Maintenance Rituximab in Patients With MCL

Dr. Hilal Discusses Study of Rituximab Maintenance in MCL

Dr. Hilal Discusses Rituximab Maintenance in Mantle Cell Lymphoma