Forstpointner R et al. (2006) Maintenance therapy with rituximab leads to a significant prolongation of response duration after salvage therapy with a combination of rituximab, fludarabine, cyclophosphamide, and mitoxantrone (R-FCM) in patients with recurring and refractory follicular and mantle cell lymphomas: results of a prospective randomized study of the German Low Grade Lymphoma Study Group (GLSG). Blood 108: 4003–4008

Treatment with a combination of rituximab and chemotherapy (R-chemotherapy) improves the prognosis of patients with follicular lymphomas (FLs) or mantle-cell lymphomas (MCLs). Forstpointner et al. have now demonstrated that maintenance therapy with rituximab (R-maintenance) after R-chemotherapy results in an improved response in lymphoma patients who are responsive to initial R-chemotherapy.

The study included patients with refractory or recurring FL or MCL who were randomized to receive fludarabine, cyclophosphamide and mitoxantrone (FCM) alone or together with rituximab (R-FCM). High response rates were observed in the R-FCM arm and 176 of these responsive patients were subsequently randomized to receive R-maintenance or no further treatment. All patients in the R-maintenance arm had a prolonged response duration compared with patients who received no maintenance (P = 0.001), and this benefit of R-maintenance remained when the analysis was restricted to patients who had received initial R-FCM therapy (P = 0.035 for those with FL and P = 0.049 for those with MCL). The estimated percentages of patients alive at 3 years were 77% after R-maintenance therapy and 57% after no maintenance (P = 0.100).

These results demonstrate that the antilymphoma activity of rituximab is maintained through all phases of treatment, and indicate that R-maintenance is a promising therapy for patients with FLs and those with MCLs, producing no significant side effects.