Department of Hematology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France.
Curr Opin Oncol. 2012 Sep;24(5):461-5. doi: 10.1097/CCO.0b013e3283562036.
In this article, we focused on the role of maintenance therapy in diffuse large B-cell lymphoma (DLBCL).
Treatment with maintenance rituximab after a response to induction therapy appears to be an effective approach to extending response duration. In randomized phase III trials, investigators have reported improved event-free and progression-free survival with maintenance rituximab in patients with newly diagnosed follicular lymphoma.
Rituximab administered as induction or maintenance therapy in combination with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) significantly prolonged event-free survival. However, continued use of rituximab after R-CHOP failed to demonstrate benefit. The necessity of a subsequent dose-intense consolidation or maintenance strategy continues to be an issue. High-dose therapy followed by autologous stem cell transplantation is the treatment of choice for patients with relapsed DLBCL who are still responding to salvage therapy. Although rituximab is effective, its role in salvage therapy after autologous transplant remains unclear. Maintenance therapy with rituximab in patients with complete remission after autologous transplant may be a useful novel approach capable of eradicating minimal residual disease. However, there are currently no data confirming this hypothesis.
本文主要聚焦于弥漫大 B 细胞淋巴瘤（DLBCL）的维持治疗作用。
在诱导治疗有反应后使用维持利妥昔单抗治疗，似乎是延长反应持续时间的有效方法。在随机 III 期试验中，研究人员报告称，在新诊断的滤泡性淋巴瘤患者中，维持利妥昔单抗治疗可改善无事件生存和无进展生存。
在联合环磷酰胺、多柔比星、长春新碱和泼尼松（CHOP）的诱导或维持治疗中应用利妥昔单抗显著延长了无事件生存。然而，R-CHOP 后继续使用利妥昔单抗未能显示获益。是否需要后续剂量密集巩固或维持策略仍是一个问题。对于仍对挽救性治疗有反应的复发性 DLBCL 患者，大剂量化疗后继自体干细胞移植是首选治疗方法。虽然利妥昔单抗有效，但它在自体移植后的挽救性治疗中的作用仍不清楚。在自体移植后完全缓解的患者中进行利妥昔单抗维持治疗可能是一种能够清除微小残留疾病的有用新方法。但目前尚无数据证实这一假说。
