Rituximab maintenance improves overall survival in follicular lymphoma: A retrospective nationwide real-world analysis from Taiwan Cancer Registry Database.

Follicular lymphoma (FL) is the most frequent indolent lymphoma in Western countries, but it is less frequent in Asia. Several trials have demonstrated the progression-free benefit of rituximab maintenance for FL patients in Western countries. However, the overall survival (OS) benefits and effectiveness of rituximab maintenance in Asian FL patients remain uncertain. We utilized the Taiwan Cancer Registry Database and the National Health Insurance Research Database to investigate the roles of rituximab maintenance for newly diagnosed FL patients in Taiwan. Among 836 patients with newly diagnosed FL during 2009-2012, we enrolled patients with stage II-IV diseases receiving 4-8 cycles of rituximab-containing induction chemotherapies (R-induction). We excluded those who died or received additional chemotherapy within 180 days after R-induction. Among the 396 enrolled patients, 260 underwent rituximab maintenance (R-maintenance group), and 136 served as the observation group. The R-maintenance group received less anthracycline and fewer cycles of R-induction than the observation group, but they exhibited a significantly better OS both in the univariate and multivariate analyses [hazard ratio, 0.42; 95% confidence interval, 0.19-0.91] after adjusting for age, sex, and Ann Arbor stages. Meanwhile, we also found more patients required further therapies in the first 6 months after the cease of rituximab maintenance. In the subgroup analysis, patients older than 60 years or with stage IV diseases benefited more from rituximab maintenance. Conclusively, our nationwide study is the first one to demonstrate the OS benefit of rituximab maintenance after induction therapies in newly diagnosed FL patients from Asian populations.