MR was also associated with a 43% reduced risk for progression. The risk of any grade infection and grade 3/4 infection was, however, higher for patients on MR.

According to the authors: “[Based] on data from randomised trials, MR improves overall survival when compared with observation and should be prescribed after a successful induction with R-CVP or an R-CHOP.”

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Nadia Khan, MD, assistant professor in the department of hematology/oncology at the Fox Chase Cancer Center in Philadelphia, Pennsylvania, noted some possible study limitations in an interview with Cancer Therapy Advisor.

“In this individual patient meta-analysis, the patient population is heterogeneous,” she said. “Why are we advocating MR for all patients with FL?”

Yet the authors did note that “based on the outcomes of this meta-analysis, the benefit of MR after frontline induction may still be questionable,” and that “it is still uncertain if that [MR improving overall survival] is true in the situation that the patient has already received rituximab in his/hers first induction.”

“It is still uncertain that MR improves overall survival after a patient has received a rituximab-containing chemotherapy induction,” Dr Khan said. She firmly believes that MR should be reserved for patients with aggressive disease who do not achieve a complete response with first-line induction.

RELATED: Hodgkin Lymphoma: Nivolumab Active After Allogeneic HCT

The National Comprehensive Cancer Network (NCCN) guidelines advise that first-line consolidation or extended dosing is optional. The recommended dosage for rituximab maintenance is 375 mg/m2 every 8 weeks for 12 doses for patients initially presenting with high tumor burden.3


  1. 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 trial. Lancet. 2011;377:42-51.
  2. Vidal L, Gafter-Gvili A, Salles G, et al. Rituximab maintenance improves overall survival of patients with follicular lymphoma-individual patient data meta-analysis. Eur J Cancer. 2017 Mar 20. doi: 10.1016/j.ejca.2017.01.021 [Epub ahead of print]
  3. B-Cell lymphomas, version 2.2017. National Comprehensive Cancer Network website. Accessed March 23, 2017.