Impact of Rituximab Maintenance on outcomes in Follicular Lymphoma: An indian experience

IF 0.8 Q4 HEMATOLOGY

Leukemia Research Reports Pub Date : 2026-01-01 Epub Date: 2025-11-29 DOI:10.1016/j.lrr.2025.100554

Harish Pant , Ajay Gogia , Atul Sharma , Naveet Wig , Hari Krishna Raju Sagiraju , Saumyaranjan Mallick , Ritu Gupta , Ahitagni Biswas

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Abstract

Background

Follicular lymphoma (FL) is the second most common subtype of non-Hodgkin lymphoma (NHL) and comprises 9 % of total NHL in India. Rituximab maintenance (RM) after induction immunochemotherapy improves PFS. However, currently, no data exists from the Indian continent regarding the impact of Rituximab maintenance (RM) on overall survival (OS) & progression-free survival (PFS). Our study aims to assess if RM improves the outcomes in FL patients.

Methods

This retrospective study included 95 patients diagnosed with FL meeting GELF criteria and registered at our institute All India Institute of Medical Sciences Delhi between January 2012 -December 2023. Among these, forty -four (46 %) patients received 2 years of RM every 2 months after induction immunochemotherapy. The primary outcome were overall survival (OS) and progression-free survival. Secondary outcomes were factors affecting OS & PFS.

Results

Out of the 95 patients who met GELF criteria, 52 were male and 43 were female, with a median age of 53 years (range: 27–81). Advanced Ann Arbor stage III/IV comprises 82 (86 %) patients. Bone marrow involvement and bulky disease were observed in 36 (38 %) and 29 (31 %) patients respectively. Based on the Follicular Lymphoma International Prognostic Index (FLIPI-1), 27 (28 %) were low risk, 9 (10 %) intermediate risk, and 59 (62 %) were high risk. The complete remission (CR) was achieved in 71 % of patients. During follow-up, 27 (28 %) patients experienced relapsed and 8 patients transformed to diffuse large B-cell lymphoma (DLBCL). At a median follow-up of 63 months, the median OS was not reached. The median PFS was 122 months in the RM group and 94 months in the non-RM group, with 5-year PFS of 91.6 % vs 59.3 %, respectively (log-rank p = 0.017). Rituximab maintenance was independently associated with improved PFS (adjusted HR 0.28, 95 % CI: 0.12–0.65, p = 0.003). Failure to attain CR (aHR 2.49, 95 % CI: 1.20–5.19, p = 0.015) and bone marrow involvement (aHR 2.92, 95 % CI: 0.99–8.63, p = 0.05) were independently associated with inferior PFS.

Conclusions

Rituximab maintenance after induction immunochemotherapy significantly improved PFS. This is the first study from India demonstrating the impact of rituximab maintenance in FL.

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利妥昔单抗维持对滤泡性淋巴瘤预后的影响：印度经验

滤泡性淋巴瘤（FL）是第二常见的非霍奇金淋巴瘤（NHL）亚型，占印度NHL总数的9%。诱导免疫化疗后利妥昔单抗维持（RM）改善PFS。然而，目前还没有来自印度大陆的关于利妥昔单抗维持（RM）对总生存期（OS）和无进展生存期（PFS）影响的数据。我们的研究旨在评估RM是否能改善FL患者的预后。方法回顾性研究纳入2012年1月至2023年12月在我们研究所全印度医学科学研究所登记的95例符合GELF标准的FL患者。其中，44例（46%）患者在诱导免疫化疗后每2个月接受2年的化疗。主要终点是总生存期（OS）和无进展生存期。次要结局是影响OS和PFS的因素。结果95例符合GELF标准的患者中，男性52例，女性43例，中位年龄53岁（范围：27-81岁）。晚期安娜堡III/IV期包括82例（86%）患者。骨髓受累36例（38%），大面积病变29例（31%）。根据滤泡性淋巴瘤国际预后指数（FLIPI-1）， 27例（28%）为低危，9例（10%）为中危，59例（62%）为高危。71%的患者达到完全缓解（CR）。在随访期间，27例（28%）患者复发，8例转化为弥漫性大b细胞淋巴瘤（DLBCL）。在中位随访63个月时，中位OS未达到。RM组和非RM组的中位PFS分别为122个月和94个月，5年PFS分别为91.6%和59.3% （log-rank p = 0.017）。利妥昔单抗维持与PFS改善独立相关（调整后危险度0.28,95% CI: 0.12-0.65, p = 0.003）。未能达到CR （aHR 2.49, 95% CI: 1.20 ~ 5.19, p = 0.015）和骨髓受累（aHR 2.92, 95% CI: 0.99 ~ 8.63, p = 0.05）与PFS较差独立相关。结论诱导免疫化疗后维持斯利妥昔单抗可显著改善PFS。这是印度第一个证明利妥昔单抗维持对FL影响的研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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