Key clinical point: Rituximab maintenance maintained until progression showed benefits in progression free- and overall survival in older patients with mantle cell lymphoma.

Major finding: Patients responding to R-CHOP had median PFS and OS times of 5.4 and 9.8 years, respectively with rituximab maintenance, vs. 1.9 years (P less than .001) and 7.1 years (P = .0026), respectively, with interferon alfa.

Study details: A random assignment of 316 initial responders between rituximab and interferon alfa maintenance, continued until progression.

Disclosures: There were no relevant conflicts of interest reported related to the research.

Commentary

“In perhaps the most important trial in MCL, patients over age 60 were randomized to receive R-CHOP or R-FC and then randomized again to rituximab maintenance vs. interferon. Unlike every trial preceding or following this study, the rituximab maintenance was to be administered indefinitely, and with a decade of follow up we now have the opportunity to explore the impact of indefinite maintenance. Interestingly, some centers mandated stopping the rituximab maintenance after 2 years, and patients treated at those centers had a significantly shorter PFS compared to patients who continued indefinite maintenance. Notably, patients treated with R-FC had more complications with maintenance compared to those treated with R-CHOP. Nonetheless, it is clear that maintenance therapy has the potential to extend life, and that longer maintenance may have additional advantages. Perhaps the question now is not whether to give maintenance or for how long, but rather who should not get maintenance and when to stop.”

Peter Martin, MD

Weill Cornell Medicine