Topline Presentation Points

Maintenance therapy in indolent NHL 

  • PRIMA Trial – Maintenance Rituximab (MR) 
    • Long term follow-up 9 years 
      • 10 yr PFS 51% vs. 35% 
      • Absolute risk reduction 16% 
      • Number needed to treat: 6-7 
      • No improvement in OS (Bachy, JCO 2019)
  • Outcomes with B + MR in British Columbia 
    • 2 yr EFS (event free survival) 
    • B+MR 85% (95% CI 80-89%) 
    • RCVP 76% (95% CI 71-80%) (Freeman, Blood 2019) 
  • Recent large RCT’s in FL 
    • GALLIUM  
      • Landmark analysis of PFS by IRC-assessed response status at end of induction therapy as assessed by Lugano 2014 criteria 
        • Obinutuzumab-based immunochemotherapy and maintenance therapy resulted in longer progression-free survival than rituximab-based therapy 
        • High-grade adverse events were more common with obinutuzumab-based chemotherapy (Marcus, NEJM 2017) (Trotman, Lancet Onc 2018)
  • RELEVANCE Len+RRituximab plus Lenalidomide in Advanced Untreated Follicular Lymphoma 
    • Among patients with previously untreated follicular lymphoma, efficacy results were similar with rituximab plus lenalidomide and rituximab plus chemotherapy (with both regimens followed by rituximab maintenance therapy) 
    • The safety profile differed in the two groups (Morschhauser, NEJM 2018)
  • STiL NHL 7-2008 MAINTAIN Trial 
    • Demonstrate PFS improvement of 2 years R-maintenance over observation after induction with B-R  
      • R-maintenance did not improve PFS or OS after B-R  
      • B-R without R-maintenance achieves a median PFS of 69 months 
      • Subgroup analyses suggest that age (>65 yrs) appears to be a significant factor for benefit of R-maintenance (Rummel, ASH 2017 Rummel, ASH 2019)
  • European MCL Elderly Trial  
    • Endpoints for R-FC versus R-CHOP induction: CR, ORR, OS, TTF, toxicity 
    • Endpoints for IFN versus rituximab maintenance: OS, remission duration, toxicity 
    • Excellent results of R-CHOP followed by rituximab maintenance until progression for older patients with MCL persisted in a mature follow-up. Prolonging rituximab maintenance beyond 2 years is effective and safe. (Kluin-Nelemans, NEJM 2012 and JCO 2019)
  • Maintenance Post-ASCT: LyMa Trial  
    • Rituximab maintenance therapy after transplantation prolonged event-free survival, progression-free survival, and overall survival among patients with mantle-cell lymphoma who were younger than 66 years of age at diagnosis. (Le Gouill, NEJM 2017) 
  • COVID-19 vaccination and CD20 mab 
    • 9 months+ post rituximab needed to see a seroconversion signal 

Ghione, Blood Adv 2021 

  • [Other] Maintenance therapy with novel agents use the chart that follows but cut out immunomodulatory portion so only Inhibitor of PI3K and Inhbitor of Btk remain