Maintenance Rituxan for CLL – pro
Since this guideline, additional evidence has accrued to support rituximab for maintenance in CLL. The strongest evidence in support of it was the Primary Rituximab and Maintenance (PRIMA) Study, in which patients received immunochemotherapy. Those who did not fail were randomly assigned to maintenance or observation. There was a longer progression-free survival in those who received rituximab maintenance, but no survival benefit. There also was the Ardeshna study, in which patients who could be observed were either randomly assigned to the watch-and-wait approach or to rituximab induction and maintenance. Time to requiring next treatment was longer if you got rituximab, but there was no survival benefit.
A recent (2013) guideliens by concluded:…better strategies are awaited for maintaining remissions in patients with CLL. In particular, further studies are needed to characterize the benefits of rituximab and other agents in maintenance therapy. Moreover, more effective drugs with low toxicities in optimal doses should be selected for future studies. According to recent guidelines, maintenance or consolidation therapy with rituximab, alemtuzumab, or lenalidomide should not be used outside of clinical trials. Well-designed, carefully controlled, randomized clinical trials should confirm the advantage of maintenance strategies over current standard therapies.”
Currently are no guidelines that recommend maintenance rituximab.
Imrie K, Stevens A, Meyer R, Hematology Disease Site Group. Rituximab in lymphoma and chronic lymphocytic leukemia: a clinical practice guideline. Toronto (ON): Cancer Care Ontario (CCO); 2005 Dec 22. 46 p. (Evidence-based series; no. 6-8). [65 references]
Salles G, Seymour JF, Offner F, et al. Rituximab maintenance for 2 years in patients with high tumour burden follicular lymphoma responding to rituximab plus chemotherapy (PRIMA): a phase 3, randomised controlled. Lancet. 2011;377:42-51. Abstract
Tadeusz Robak, Maintenance in CLL. Blood 2013 122:3854-3855
Read the Layperson version here.