Systematic Review Of Maintenance Rituximab Therapy In B Cell Non-Hodgkin Lymphoma

Objective:To evaluate the efficacy of maintenance rituximab therapy in B cell NHL.Materials and Methods: RCTs on maintenance rituximab treatment for adult NHL were identified from PubMed,EMbase,The Cochrane Library,Cochrane Central Register of Controlled Trial(CENTRAL),Current Controlled Trials,CBM,CMCC,VIP,CNKI .Two reviewers assessed the quality of the trials and extracted data separately,they cross check them. The methodological quality of included studies was assessed,and a systematic review was performed used the Cochrane Collaboration's software RevMan 4.2.2.Main results:Seven RCTs including a total of 1568 patients were investigated, These studies were of poor methodological quality. As different entry criteria ,treatment protocol and response criteria were used in the included studies, we decided to provide a descriptive summary only. Four trials showed that maintenance rituximab treatment could improve PFS of indolent NHL.Two trials indicated that maintenance rituximab therapy improved EFS of FL and pretreated MCL. One trial indicated FFS was prolonged with MRT after CHOP but not after RCHOP in Older Patients With DCBCL. Five trials reported overall survival,Two trials suggested that maintenance rituximab therapy increased OS,But three trials indicated there was no difference and reached a conflicting conclusion. Additional follow up of these seven trials is required. MRT approaches were well tolerated in the seven trials,only two trials suggested more hematological toxicity.Conclusions:1) Maintenance rituximab therapy could improve PFS of relapsed/resistant follicular NHL,MCL and indolent NHL ;2) maintenance rituximab therapy improved EFS of FL and pretreated MCL but not newly diagnosed MCL;3) FFS was prolonged with maintenance rituximab therapy after CHOP but not after RCHOP in older patients with DCBCL;Part of these trials reported OS was improved with maintenance rituximab therapy , Additional follow up of these seven trials is required.At present,there is a lack of understanding of the indication ,usage and duration of maintenance rituximab therapy,further foundation and clinical researches and a unitive assessment criteria of tumor is necessary.In order to make further evaluation on the effects of maintenance rituximab therapy,some well designed prospective multicenter randomized controlled double-blind clinical trials is necessary.