Maintenance Therapy for CD20+ Indolent Lymphoma: Who Should Receive Maintenance?

Authors

  • Edward Koo, MD Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Ontario
  • David A. Macdonald, MD, FRCPC Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Ontario

DOI:

https://doi.org/10.58931/cht.2024.3150

Abstract

Maintenance rituximab (MR) has been a mainstay of treatment in Canada for CD20‑positive indolent lymphoma for two decades. The adoption of MR into clinical practice occurred after the publication of the EORTC 20981 trial. This trial showed a significant improvement in progression free survival (PFS) with two years of MR versus observation after induction therapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in patients with relapsed follicular lymphoma (FL). The use of MR was broadly extended to include its use in the front‑line setting, following any R-containing inductions and including all CD20-positive indolent lymphoma histologies.

Automatic recommendations for MR became the standard practice for most patients. Given the recent changes to standard induction regimens in some indications, and with heightened concerns about infectious complications during B-cell depleting therapy, the recommendation for the use of MR should no longer be considered automatic. This review offers a balanced perspective of the evidence for MR.

Author Biographies

Edward Koo, MD, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Ontario

Dr. Edward Koo is a fourth-year resident in the Adult Hematology Program at the University of Ottawa. He completed medical school at McMaster University followed by residency in Internal Medicine at Dalhousie University.

David A. Macdonald, MD, FRCPC, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Ontario

Dr. David Macdonald is a hematologist in the Malignant Hematology Group at the Ottawa Hospital, and Assistant Professor at the University of Ottawa. He is a member of the Scientific Advisory Board for Lymphoma Canada and is a contributor to the lymphoma working group of CCTG. His clinical practice focuses on lymphoma and chronic lymphocytic leukemia, and his research interests centre on clinical trials of novel therapies in lymphoma and CLL.

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Published

2024-04-25

How to Cite

1.
Koo E, Macdonald DA. Maintenance Therapy for CD20+ Indolent Lymphoma: Who Should Receive Maintenance?. Can Hematol Today [Internet]. 2024 Apr. 25 [cited 2024 May 20];3(1):44–50. Available from: https://canadianhematologytoday.com/article/view/3-1-Koo_et_al

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