Comment

摘要

Rummel and colleagues' study comes at an important time in the treatment of indolent non-Hodgkin's lymphoma, when the addition of rituximab as first-line maintenance treatment is known to improve progression-free survival. In the PRIMA study,10 patients with untreated follicular lymphoma received one of three chemoimmunotherapy induction regimens, including R-CHOP, which was given to about 75% of patients. Those who responded to chemoimmunotherapy were randomly assigned to either observation or maintenance rituximab (375 mg/m2 every 8 weeks for 2 years). 3-year progression-free survival was 75% in the rituximab maintanence group versus 58% in the observation group. Similar findings have been shown after CVP and single-agent rituximab.1112 Results of the PRIMA study are in line with those for patients with follicular lymphoma in Rummel and colleagues' study, showing a 3-year progression-free survival of 70% after bendamustine plus rituximab versus only 50% after R-CHOP alone (table). In.the PRIMA study, patients in the rituximab maintenance group had more toxic effects than did those in the observation group; however, in both groups, grade 2-4 infections were the most common adverse event (39% and 24%, respectively). This result draws attention to several unresolved questions: how does bendamustine plus rituximab compare with R-CHOP, with rituximab for the first-line maintenance treatment of indolent non-Hodgkin's lymphoma? Does rituximab maintenance have a role after bendamustine plus rituximab, and could that use, or the addition of other drugs, further improve outcomes with this combination treatment? Finally, how do the two treatment options, if equally effective, compare in cost?