Maintenance Therapy in Lymphoma

Maintenance therapy refers to the ongoing treatment of patients whose disease has responded well to frontline or first-line (initial) treatment. Maintenance therapy is used to keep the cancer in remission (disappearance of signs and symptoms), by removing any lymphoma cells that are not detected in routine tests after frontline treatment.

Maintenance therapy typically consists of nonchemotherapy drugs given at lower doses and longer intervals than those used during induction therapy (initial treatment). Depending on the type of lymphoma and the medications used, maintenance therapy may last for weeks, months, or even years. The monoclonal antibody (a protein made in the laboratory that binds to cancer cells and helps the immune system destroy them) rituximab (Rituxan) is commonly used as maintenance therapy in lymphoma. It can be given intravenously (infused directly into a vein) or by subcutaneous (under the skin; Rituxan Hycela) injection. As new effective treatments with limited toxicity are developed, more drugs are likely to be used as maintenance therapies.

Although the medications used for maintenance treatments generally have fewer side effects than chemotherapy, patients may still experience adverse events. Doctors consider the patient’s clinical condition before determining the best induction therapy. After induction therapy is completed, the doctor then decides whether the patient would benefit from maintenance therapy, retreatment, or the active surveillance (also known as “watchful waiting” or “careful observation”) approach. With the active surveillance strategy, patients’ overall health and disease are monitored through regular checkups and various evaluating procedures, that may include laboratory tests (like a complete blood cell count), physical examinations (like checking for any swelling), and imaging (such as a computed tomography [CT] or positron emission tomography [PET] scan). Active treatment is started if the patient begins to develop lymphoma-related symptoms or there are signs that the disease is progressing based on testing performed during follow-up visits.

For more information on maintenance therapy, please view the Understanding Lymphoma and CLL Guide on the Foundation’s website (visit lymphoma.org/publications).

Maintenance therapy has traditionally been used for indolent (slow growing) non-Hodgkin lymphoma subtypes such as follicular lymphoma; however, researchers are currently studying the value of using maintenance therapies in many other subtypes of lymphoma.

Questions that patients can ask their doctor to help them better understand the role of maintenance therapy in their treatment course include:

• Is maintenance therapy an option for me?
• Why are you recommending maintenance therapy?
• What are the benefits and risks?
• How often and for how long will I receive this treatment?
• What side effects might I experience? Are the side effects expected to increase as I continue on maintenance therapy?
• Does my insurance cover this treatment?
• Is maintenance therapy better for me than active surveillance followed by this same therapy if the lymphoma returns?
• Will the use of maintenance therapy have any impact on any future therapies I may need?