title: A systematic review of comparative schedule-related toxicities with maintenance rituximab in follicular and mantle cell lymphomas.
abstract: Abstract We conducted a systematic review of grade 3/4 adverse events (AEs) reported in prospective trials enrolling patients with follicular lymphoma (FL) and mantle cell lymphoma (MCL) receiving maintenance rituximab (MR). Random-effects models were used to calculate summary estimates and 95% confidence intervals for the proportion of AEs occurring during MR. Differences by induction program, histology, setting and MR schedule were examined by stratified analyses and univariate random-effects meta-regression. Eleven trials met the search criteria, with nine sufficiently reporting AEs during the MR phase. Of 1009 patients receiving MR, the proportion experiencing cumulative grade 3/4 toxicity was 24% (95% confidence interval [CI]: 14-36%). Patients receiving MR every 6 months as four weekly infusions for 2 years had significantly less toxicity compared with those receiving MR every 2 months (10% vs. 28%; p = 0.035). Patients treated with rituximab alone during induction had fewer toxicities compared to those treated with rituximab plus chemotherapy induction (12% vs. 35%; p = 0.031). Myelosuppression and infections were the most common toxicities. Our literature analysis suggests that MR given every 6 months and rituximab alone as induction may be associated with fewer grade 3/4 AEs for patients with FL and MCL; however, assessing the true independent impact of induction regimens and schedule on toxicity will require prospective trials.
authors.affiliation: Section of Hematology and Oncology, Department of Medicine.
authors.forename: Chadi
authors.initials: C
authors.lastname: Nabhan
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Ollberding
authors.forename: Dana
authors.initials: D
authors.lastname: Villines
authors.forename: Brian C-H
authors.initials: BC
authors.lastname: Chiu
authors.forename: Donne Bennett D
authors.initials: DB
authors.lastname: Caces
authors.forename: Tina V
authors.initials: TV
authors.lastname: Valdez
authors.forename: Michele
authors.initials: M
authors.lastname: Ghielmini
authors.forename: Shu-Fang
authors.initials: SF
authors.lastname: Hsu Schmitz
authors.forename: Sonali M
authors.initials: SM
authors.lastname: Smith
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D004334:Drug Administration Schedule; D006801:Humans; D008224:Lymphoma, Follicular / Q000188:drug therapy*; D020522:Lymphoma, Mantle-Cell / Q000188:drug therapy*; D060046:Maintenance Chemotherapy; D000069283:Rituximab; D016896:Treatment Outcome
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000069283:Rituximab
keywords: Rituximab; follicular lymphoma; lymphoma; maintenance rituximab; mantle cell lymphoma