Among elderly patients with mantle cell lymphoma (MCL), rituximab maintenance therapy appears to yield notable clinical benefit, according to a real-world analysis published in Haematologica. The benefits were noted, furthermore, among patients who did not undergo stem cell transplant (SCT).

Clinical trials have shown that patient with MCL may benefit from rituximab maintenance after standard R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) therapy compared with maintenance interferon.

In recent years, however, clinicians have begun relying less on R-CHOP, rendering unclear whether rituximab maintenance provides clinical benefit in the real world. For this study, researchers reviewed Medicare data to evaluate the effectiveness of rituximab maintenance among elderly patients with MCL who undergo chemo-immunotherapy.

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The investigators included patients who were at least 66 years old and were diagnosed with MCL between 2007 and 2017. Patients received first-line R-CHOP or bendamustine plus rituximab followed by rituximab maintenance and no stem cell transplantation (SCT). Only data from patients who survived at least 200 days without second-line therapy or patients with a gap of at least 200 days between completing first-line and initiating second-line therapy were included.

Overall, data from 1579 patients with MCL were evaluated; the most common first-line regimens were bendamustine plus rituximab (37%) and R-CHOP (17%). Of the patients who received 1 of these first-line treatments, 44% received rituximab maintenance, and 3% received SCT.

Initial analysis showed that R-CHOP use decreased during the study period, from 31% in 2007 to 5% in 2017, while bendamustine use increased from 1% to 41%.

The final cohort included 386 patients who had received R-CHOP or bendamustine; among these, the median age was 75 years and 67% of patients were male sex. Covariates were balanced.

Analysis of this cohort showed that patients who received rituximab maintenance had a reduced likelihood of all-cause mortality (hazard ratio [HR], 0.59; 95% CI, 0.42-0.84), mortality from MCL (sub-HR, 0.53; 95% CI, 0.35-0.81), and initiating second-line therapy (sub-HR, 0.60, 95% CI, 0.44-0.82).

“In conclusion, our population-based real-world analysis showed significant benefits of RM in survival and disease control among older patients with MCL who did not receive [SCT], despite the shift from R-CHOP to [bendamustine plus rituximab] as first-line induction,” the authors wrote in their report.


Di M, Long JB, Kothari SK, et al. Treatment patterns and real-world effectiveness of rituximab maintenance in older patients with mantle cell lymphoma: a population-based analysis. Haematologica. Published online January 19, 2023. doi:10.3324/haematol.2022.282252