Long Term Follow-up of International Randomised Phase 3 Study of Rituximab Versus a Watch and Wait Approach for Patients with Asymptomatic, Low Tumour Burden Follicular Lymphoma Shows Rituximab Is Highly Effective at Delaying Time to New Treatment without Detrimental Impact Following Next Line of Therapy

Randomized Phase III Trial Evaluating Subcutaneous Rituximab for the First-Line Treatment of Low–Tumor Burden Follicular Lymphoma: Results of a LYSA Study

“…22 TTNT is an important goal for such patients, and the lack of TTNT improvement is disappointing even if a tendency was observed with TTNCT. This was also found in initial analysis of the UK trial, 4 but its recent update, 8 with a longer follow-up, has shown a significant advantage of prolonged maintenance over no maintenance. Progression is the usual end point in FL and was chosen as the primary end point to calculate the number of patients to be included.…”

“…The addition of rituximab maintenance for 2 years increased significantly PFS and TTNT compared with rituximab induction 8 but increased the cost of treatment compared with the rituximab retreatment strategy and led to more treatment discontinuations. 5 Although the benefit of a rituximab induction was significant, these results question the use of prolonged rituximab maintenance.…”

“…6 Thus, the National LymphoCare Study 7 showed that rituximab is used in daily practice for those patients. Indeed, four-weekly rituximab induction 4 showed a significantly prolonged progression-free survival (PFS) and time to next treatment (TTNT) compared with W&W. The addition of rituximab maintenance for 2 years increased significantly PFS and TTNT compared with rituximab induction 8 but increased the cost of treatment compared with the rituximab retreatment strategy and led to more treatment discontinuations. 5 Although the benefit of a rituximab induction was significant, these results question the use of prolonged rituximab maintenance.…”

“…Similarly, 64.1% and 49.4% of patients receiving rituximab induction with or without prolonged maintenance, respectively, were free of new treatment at 10 years in the UK trial. 8 In the meantime, the SAKK group demonstrated that a short maintenance with four rituximab infusions every two months after rituximab induction 10,11 could also be an approach to maintain response to rituximab.…”

A low total metabolic tumor volume independently predicts for a longer time to first treatment in initially observed, low tumor burden follicular lymphoma

“…Long-term data of the randomized trial comparing single-agent rituximab with WW in LTB patients were recently presented. 7 With a median follow-up of 12.3 years, rituximab monotherapy was highly effective at prolonging time to next treatment, and outcomes with subsequent lines of treatment were not inferior compared with that of patients undergoing initial observation. Our data could help identify a subset of asymptomatic patients (LTB, high TMTV) who could benefit most from single-agent rituximab, although this hypothesis remains to be proven in the setting of prospective clinical trials.…”