Maintenance therapy is often used with several lymphoma subtypes with the aim to keep the lymphoma in remission for longer
What is maintenance therapy?
Maintenance therapy refers to the ongoing treatment after the initial treatment has put the lymphoma into remission (the lymphoma has reduced or has responded to treatment). The aim is to make the remission last as long as possible. The most common type of therapy used in maintenance is with an antibody (such as Rituximab or Obinutuzumab).
Chemotherapy is sometimes used as maintenance therapy for children and young people with lymphoblastic lymphoma. They are usually started within the first 6 months following initial treatment to keep lymphoma from progressing or recurring.
How long will maintenance therapy last?
Depending on the type of lymphoma and the drugs used, maintenance therapy may last for weeks, months, or even years. Not all patients are recommended to have maintenance therapy if their lymphoma is under control after induction treatment. It has been found to have benefits in certain subtypes of lymphoma.
Rituximab is a monoclonal antibody that is often recommended as maintenance therapy in patients with many different forms of non-Hodgkin lymphoma (NHL). These patients have usually received rituximab as part of their induction therapy, most commonly in combination with chemotherapy (called chemoimmunotherapy).
If the lymphoma responds to initial treatment, rituximab may be recommended to be continued as ‘maintenance therapy’. The rituximab in the maintenance phase is administered once every 2–3 months. Rituximab is currently given for a maximum period of 2 years, although clinical trials are testing whether there is any benefit in maintenance treatment continuing for longer. For maintenance therapy, rituximab may be given intravenously (by injection into a vein) or subcutaneously (by injection under the skin).
Alternatively, Obinutuzumab (Gazyva) is another monoclonal antibody that is also used for maintenance for patients with follicular lymphoma post chemotherapy. The Obinutuzumab is administered every 2 months for 2 years.
Who receives maintenance therapy?
Maintenance rituximab has mainly been used in the indolent NHL subtypes such as follicular lymphoma. Maintenance therapy is currently being looked at in other subtypes of lymphomas. Children and young people with lymphoblastic lymphoma may be given maintenance treatment with chemotherapy to prevent their lymphoma relapsing. This is a less intensive course of chemotherapy.
What are the benefits of maintenance therapy?
Having maintenance therapy with rituximab or Obinutuzumab can increase the length of remission in patients with follicular or mantle cell lymphoma. Research has shown that relapses can be delayed or even prevented, by continuing or ‘maintaining’ treatment with rituximab whilst patients are in remission. The goal is to prevent the patients who have responded to initial treatment from relapsing while ultimately improving overall survival. In Australia, this is only publicly funded (PBS) for rituximab in follicular lymphoma.
The risks of maintenance therapy
Although the drugs used for maintenance treatments generally have fewer side effects than combination chemotherapy, patients may still experience adverse events from these treatments. The doctor will consider all the clinical circumstances before determining the initial treatment and whether the patient would benefit from maintenance therapy versus another treatment or ‘watch and wait’.
Most patients do not have many troublesome side effects whilst on rituximab. However, it is not always suitable for everyone to receive maintenance therapy. Some of the possible side effects of maintenance Rituximab are:
- Allergic reaction
- Lowering effects on blood cells
- Headaches or flu like symptoms
- Fatigue or tiredness
- Skin changes such as a rash
Treatments under investigation as maintenance therapy
Many new individual and combination therapies are being trialled around the world for their use in maintenance therapy for lymphoma. Some of these drugs include:
- Bortezomib (Velcade)
- Brentuximab vedotin (Adcetris)
- Lenalidomide (Revlimid)
- Vorinostat (Zolinza)
Scientific research is continuously evolving. Treatment options may change as new treatments are discovered and treatment options are improved.
You can access further information about the maintenance therapy that you are receiving by following the links below: