Changes to This Summary (04/24/2015)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Added Related Summaries as a new subsection.
Added text to state that after induction therapy with rituximab only or with rituximab plus chemotherapy, rituximab can be used once every 2 to 3 months; several studies have evaluated this approach.
Revised text to state that in the PRIMA (NCT00140582) study, 1,019 high-risk, previously untreated, symptomatic patients achieved complete or partial response after induction therapy with immunochemotherapy and were then randomly assigned to 2 years of maintenance rituximab versus no maintenance.
Added text to state that in the UK/International study (NCT00112931), 379 previously untreated patients with asymptomatic, low-burden disease were randomly assigned to watchful waiting versus rituximab induction only versus rituximab induction followed by 2 years of rituximab maintenance (cited Ardeshna et al. as reference 66 and level of evidence 1iiC). Also added that overall survival (OS) and histologic transformation rates were no different at 3 years, but maintenance rituximab was favored based on quality-of-life studies and time-to-initiation of new treatment by 3 years.
Added text to state that this study suggested that for some patients, "watch and wait" resulted in "watch and worry" (cited Ansell as reference 67) and concluded that from the perspective of OS and histologic transformation rates, no benefit could be seen with rituximab maintenance.
Revised text to state that palliation may be achieved with very low-dose, involved-field radiation therapy in two fractions for patients with indolent and aggressive relapsed disease. Also added that in a prospective randomized trial, treatment with 4 Gy was inferior to treatment with 24 Gy in 12 fractions for progression-free survival (cited Hoskin et al. as reference 31 and level of evidence 1iiDiii).
Revised text to state that clinical trials continue to explore modifications of cyclophosphamide, hydroxydaunorubicin, vincristine, and prednisone (CHOP) and rituximab with CHOP (R-CHOP) by increasing doses, reducing intervals between cycles, combining new drugs with new mechanisms of action, or applying extra doses of rituximab (cited Pfreundschuh et al. as reference 15).
Added Additive radiation therapy as a new subsection.
This summary is written and maintained by the PDQ Adult Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ NCI's Comprehensive Cancer Database pages.