The result of maintenance therapy with rituximab in extra nodal lymphoma

Abstract

Objective: Maintenance treatment with rituximab has been used in some nodal lymphomas, such as follicular and diffuse large cell lymphoma. The aim of this study was to evaluate the survival of extra nodal lymphoma patients under maintenance treatment.

Materials and methods: From July 2008 to December 2017, after induction treatment in patients with extra nodal lymphoma, if the patients consented and the drug was available, they were treated with rituximab every 3 months for 2 years.

Results: A total of 112 patients with extra nodal lymphoma met the inclusion criteria. Among them, 89 patients had high-grade lymphomas and 23 patients were in the group of low-grade lymphomas. The group of patients with high-grade lymphoma who received the rituximab-containing regimen as a maintenance treatment had lower rates of recurrence and death compared to the group that received rituximab only in the induction phase. In patients with low-grade lymphoma, the recurrence rate and mortality were also lower in the group receiving maintenance treatment compared to other groups, but the difference was not statistically significant.

Conclusion: The use of rituximab in patients with extra nodal lymphoma as maintenance can increase the survival of the patients.

Keywords

extra nodal lymphoma / maintenance therapy / rituximab / R-CHOP / R-CVP

References

[1] d'Amore F , Christensen BE , Brincker H , et al. Clinicopathological features and prognostic factors in extranodal non-Hodgkin lymphomas. Danish LYFO Study Group. Eur J Cancer. 1991; 27 (10): 1201- 1208.

[2] Arbyn M , Weiderpass E , Bruni L , Bruni L . Primary extranodal non-Hodgkin's lymphomas. Part 1: Gastrointestinal, cutaneous and genitourinary lymphomas. Ann Oncol. 1997; 8 (8): 727- 737.

[3] Zucca E , Roggero E , Bertoni F , Conconi A , Cavalli F . Primary extranodal non-Hodgkin's lymphomas. Part 2: Head and neck, central nervous system and other less common sites. Ann Oncol. 1999; 10 (9): 1023- 1034.

[4] Müller AMS , Ihorst G , Mertelsmann R , Engelhardt M . Epidemiology of non-Hodgkin's lymphoma (NHL): trends, geographic distribution, and etiology. Ann Hematol. 2005; 84 (1): 1- 12.

[5] Yadlapati S , Efthimiou P . Autoimmune/inflammatory arthritis associated lymphomas: who is at risk? BioMed Res Int. 2016; 2016: 8631061.

[6] Engels EA . Infectious agents as causes of non-Hodgkin lymphoma. Cancer Epidemiol Biomarkers Prev. 2007; 16 (3): 401- 404.

[7] Ferry JA . Extranodal lymphoma. Arch Pathol Lab Med. 2008; 132 (4): 565- 578.

[8] Otter R , Gerrits WB , vd Sandt MM , Hermans J , Willemze R . Primary extranodal and nodal non-Hodgkin's lymphoma. Eur J Cancer Clin Oncol. 1989; 25 (8): 1203- 1210.

[9] d'Amore F , Brincker H , Grønbaek K , et al. Non-Hodgkin's lymphoma of the gastrointestinal tract: a population-based analysis of incidence, geographic distribution, clinicopathologic presentation features, and prognosis. Danish Lymphoma Study Group. J Clin Oncol. 1994; 12 (8): 1673- 1684.

[10] Mian M , Capello D , Ventre MB , et al. Early-stage diffuse large B cell lymphoma of the head and neck: clinico-biological characterization and 18 year follow-up of 488 patients (IELSG 23 study). Ann Hematol. 2014; 93 (3): 221- 231.

[11] Lee YH , Cho SG , Jung SE , et al. Analysis of treatment outcomes for primary tonsillar lymphoma. Radiat Oncol J. 2016; 34 (4): 273- 279.

[12] Bradford PT , Devesa SS , Anderson WF , Toro JR . Cutaneous lymphoma incidence patterns in the United States: a population-based study of 3884 cases. Blood. 2009; 113 (21): 5064- 5073.

[13] Chalastras T , Elefteriadou A , Giotakis J , et al. Non-Hodgkin's lymphoma of nasal cavity and paranasal sinuses. A clinicopathological and immunohistochemical study. Acta Otorhinolaryngol Ital. 2007; 27 (1): 6- 9.

[14] Mytelka DS , Li L , Stafkey-Mailey D , et al. Treatment patterns and outcomes among patients with high-intermediate/high-risk diffuse large B-cell lymphoma in the USA. Hematology. 2014; 20 (8): 442- 448.

[15] Ren YR , Jin YD , Zhang ZH , Li L , Wu P . Rituximab treatment strategy for patients with diffuse large B-cell lymphoma after first-line therapy: a systematic review and meta-analysis. Chin Med J. 2015; 128 (3): 378- 383.

[16] Zhou X , Ma T , Zhang Y , Zhou N , Li J . Rituximab maintenance therapy for patients with diffuse large B-cell lymphoma: a meta-analysis. PLoS One. 2017; 12 (3): e0174648.

[17] 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 (9759): 42- 51.

[18] Forstpointner R , Unterhalt M , Dreyling M , et al. Maintenance therapy with rituximab leads to a significant prolongation of response duration after salvage therapy with a combination of rituximab, fludarabine, cyclophosphamide, and mitoxantrone (R-FCM) in patients with recurring and refractory follicular and mantle cell lymphomas: results of a prospective randomized study of the German Low Grade Lymphoma Study Group (GLSG). Blood. 2006; 108 (13): 4003- 4008.

[19] Berinstein NL , Grillo-López AJ , White CA , et al. Association of serum rituximab (IDEC-C2B8) concentration and anti-tumor response in the treatment of recurrent low-grade or follicular non-Hodgkin's lymphoma. Ann Oncol. 1998; 9 (9): 995- 1001.

[20] Yogi V , Singh OP , Redhu P , Francis B . Extranodal non-Hodgkin lymphomas: the impact of different variables on the disease. Middle East Journal of Cancer. 2019; 10 (4): 324- 332.

[21] Bello-Castro A , Mosquera-Orgueira A , Gude-Smpedro F , et al. Prognostic and survival factors in head and neck extra-nodal non-Hodgkin's lymphoma. Oral Surg Oral Med Oral Pathol Oral Radiol. 2025; 139 (2): 201- 210.

RIGHTS & PERMISSIONS

The Author(s). Malignancy Spectrum published by John Wiley & Sons Australia, Ltd on behalf of Higher Education Press.