Efficacy of maintenance rituximab post-R-CHOP questioned in COM/DIS NHL patients

In a recently published letter to the editor of Haematologica, Roopesh Kansara, from the British Columbia Cancer Agency, Canada, and colleagues reported the results of a retrospective study of the use of maintenance rituximab (MR) in newly diagnosed Non-Hodgkin Lymphoma (NHL) patients. The authors set out to understand the optimal treatment of Composite (COM) and Discordant (DIS) NHL patients, as typically they are excluded from published trials. Data used was from 43 patients treated for COM/DIS NHL with R-CHOP before the treatment policy changed in 2006, and 55 patients treated with R-CHOP followed by MR after 2006.

Highlights:

• COM = 59% (58pts), DIS = 41% (40pts)
• MR dose post R-CHOP: 375 mg/m² every 3 months for two years (8 doses)
• COM = 59% (58pts), DIS = 41% (40pts)
• No statistical differences in outcomes with or without MR
• PFS HR 0.73, 95% CI: 0.41–1.31, P=0.288. COM P=0.407, DIS P=0.638
• OS HR 0.95, 95% CI: 0.46–1.95, P=0.889. COM P=0.536, DIS P=0.494

The authors concluded by stating that the addition of MR did not result in improved overall outcomes, or when comparing just COM or DIS patients. They also mentioned some issues with their study including a small sample size, differences in follow-up time, lack of standardized imaging, lack of cytogenetic marker status being captured, and differences in baseline characteristics between groups such as age. Further studies, especially prospective ones, are required to elucidate any benefits of MR following successful R-CHOP treatment in patients with newly diagnosed COM/DIS NHL.