Page 27 - Haematologica Vol. 110 - January 2025

EDITORIAL
A. Noy
PFS and OS in a subset study of the prospective Stil trial,7 some ‘real-world’ retrospective analyses found maintenance rituximab added substantial value.8,9 Moreover, maintenance rituximab is currently standard after first-line therapy fol- lowed by consolidative autologous stem cell transplant10 or as part of an induction incorporating Bruton tyrosine kinase inhibitors.11 We should not group these MCL patients together with FL patients when making decisions about maintenance rituximab.
New therapeutics such as chimeric antigen receptor T-cell therapy and bispecific antibodies will increasingly be used for indolent lymphomas. Yet we must be mindful of the pro- longed immunosuppression of both B and T cells, especially if we incorporate these agents into earlier lines of therapy in the future where they might be used for an increasingly larger proportion of patients. Serna et al. demonstrate we also need to pay attention to the risk of infection and not only to the benefits of such a therapeutic approach. Finally, what take home message should we have for our patients? While the COVID vaccination seroconversion rates were low (22%), many of these patients would have already
References
1. Serna A, Navarro V, Iacoboni G, et al. Rituximab maintenance after bendamustine-based treatment for follicular lymphoma and mantle cell lymphoma may exert a negative influence on SARS-CoV-2 infection outcomes. Haematologica. 2025;110(1):173-178.
2. Rummel MJ, Niederle N, Maschmeyer G, et al. Bendamustine plus rituximab versus CHOP plus rituximab as first-line treatment for patients with indolent and mantle-cell lymphomas: an open-label, multicentre, randomised, phase 3 non-inferiority trial. Lancet. 2013;381(9873):1203-1210.
3. Flinn IW, van der Jagt R, Kahl BS, et al. Randomized trial of bendamustine-rituximab or RCHOP/R-CVP in first-line treatment of indolent NHL or MCL: the BRIGHT Study. Blood. 2014;123(19):2944-2952.
4. Hiddemann W, Barbui AM, Canales MA, et al. Immunochemotherapy with obinutuzumab or rituximab for previously untreated follicular lymphoma in the GALLIUM Study: influence of chemotherapy on efficacy and safety. J Clin Oncol. 2018;36(23):2395-2404.
5. Olszewski AJ, Butera JN, Reagan JL, Castillo JJ. Outcomes of bendamustine- or cyclophosphamide-based first-line chemotherapy in older patients with indolent B-cell lymphoma. Am J Hematol. 2020;95(4):354-361.
6. Bachy E, Seymour JF, Feugier P, et al. Sustained progression- free survival benefit of rituximab maintenance in patients with follicular lymphoma: long-term results of the PRIMA Study. J
received their induction chemoimmunotherapy prior to the availability of vaccines in early 2021. Although not detailed in the paper, the conversion rate must be presumed higher if vaccination precedes chemoimmunotherapy induction. In light of ongoing vaccine hesitancy in general and COVID complacency, it is imperative we, the providers, advocate for vaccination against COVID and other viruses prior to the start of therapy whenever feasible. We can also advise prompt treatment of COVID infection with antivirals and prophylaxis with monoclonal antibody when available and appropriate. We have an opportunity and a mandate to save lives.
Disclosures
AN reports professional services and activities for the follow- ing: ADC Therapeutics, AstraZeneca, BeiGene Ltd., ClearView Healthcare Partners, Epizyme, EUSA Pharma, ExpertCon- nect, Gerson Lehrman Group, Guidepoint Global Advisors, Health Advances LLC, Janssen Global Services LLC, Medal- lion Healthcare, NSCI Group Inc., OncLive, PER Events LLC, Raphael Pharmaceuticals, Recordati S.p.A., Insights, Insights and Techspert.io Ltd.
Clin Oncol. 2019;37(31):2815-2824.
7. Rummel MJ, Knauf W, Goerner M, et al. Two years rituximab
maintenance vs. observation after first-line treatment with bendamustine plus rituximab (B-R) in patients with mantle cell lymphoma: first results of a prospective, randomized, multicenter phase II study (a subgroup study of the StiL NHL7- 2008 MAINTAIN trial). J Clin Oncol. 2016;34(15 Suppl):7503.
8. Martin P, Cohen JB, Wang M, et al. Treatment outcomes and roles of transplantation and maintenance rituximab in patients with previously untreated mantle cell lymphoma: results from large real-world cohorts. J Clin Oncol. 2023;41(3):541-554.
9. Wang Y, Larson MC, Kumar A, et al. Benefit of rituximab maintenance after first-line bendamustine-rituximab in mantle cell lymphoma. J Clin Oncol. 2024;42(16 Suppl):7006.
10. Sarkozy C, Thieblemont C, Oberic L, et al. Long-term follow-up of rituximab maintenance in young patients with mantle-cell lymphoma included in the LYMA Trial: a LYSA Study. J Clin Oncol. 2024;42(7):769-773.
11. Dreyling M, Doorduijn J, Giné E, et al. Ibrutinib combined with immunochemotherapy with or without autologous stem-cell transplantation versus immunochemotherapy and autologous stem-cell transplantation in previously untreated patients with mantle cell lymphoma (TRIANGLE): a three-arm, randomised, open-label, phase 3 superiority trial of the European Mantle Cell Lymphoma Network. Lancet. 2024;403(10441):2293-2306.
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