Rituximab maintenance therapy for mantle cell lymphoma: A systematic review and meta-analysis

Mantle cell lymphoma is characterized by relapse and progressive disease, despite initial response to chemoimmunotherapy. We conducted a systematic review and meta-analysis to determine the efficacy of rituximab maintenance (RM) therapy in patients with mantle cell lymphoma. We searched PubMed, Embase and Cochrane Central Register of Controlled Trials from database inception through November 1, 2017. Only full-text articles were included. Prespecified data elements were extracted from each trial. Outcomes of interest included progression-free survival (PFS) and overall survival (OS). The overall effect was pooled using the Der Simonian-Laird random effects model. Three randomized controlled trials and four observational studies met our inclusion criteria and were identified in the analyses. Six studies compared RM therapy to observation, and one compared RM therapy to interferon alfa. Meta-analysis evaluating outcomes of patients treated after ASCT revealed that RM improved for both PFS (HR= 0.33, 95% CI= 0.23-0.49) and OS (HR of death= 0.35, 95% CI= 0.17-0.69). A second meta-analysis of studies evaluating outcomes of patients who are ASCT-ineligible treated with anthracycline-based induction therapy revealed that RM improved PFS (HR= 0.38, 95% CI= 0.25-0.58). There is a paucity of data on the role of RM in ASCT-ineligible patients and those with relapsed disease. Overall, RM therapy appears to improve PFS and OS in previously untreated patients with mantle cell lymphoma who undergo induction chemoimmunotherapy followed by ASCT.