The role of maintenance strategies in lymphoma and CLL


Maintenance treatment is used in patients if a curative therapy is not available and is currently explored where curation rates need to be improved in aggressive lymphoma. A discussion of valid endpoints is specifically important in the case of indolent lymphoma. The most valid endpoint for maintenance treatment is clearly overall survival, but adequate trial designs may be difficult to achieve and times to relevant results may be excessive. Therefore other endpoints such as quality-adjusted life year or the time to resistance to maintenance treatment or to resistance to repeated reinduction therapies are explored. Several drugs are used for maintenance treatment. The best data exist for interferon alfa and Rituximab. Interferon alfa is able to prolong survival in indolent lymphoma, but it has too many side effects. Rituximab had proven efficacy in second remission in follicular lymphoma and may be useful even in first remission. It has also proven effective in mantle-cell, marginal, and small lymphocytic lymphoma. Maintenance strategies for chronic lymphocytic leukemia have only been explored in phase II designs so far. However, a number of trials currently explore the use of Rituximab or Lenalidomide in a randomized fashion for chronic lymphocytic leukemia maintenance. At all entities included in the overview, several maintenance treatment trials are under way and patients are to be entered in these trials.