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Leo I. Gordon, MD, FACP


Long-Term Update on Upfront Rituximab Versus ‘Watch and Wait’ in Follicular Lymphoma

By: Vanessa A. Carter, BS
Posted: Thursday, January 26, 2023

Michael Northend, MBBS, BSc, MRCP, FRCPath, of University College Hospital, London, and colleagues performed the phase III ‘Watch and Wait’ trial, evaluating rituximab versus an observation approach among patients with follicular lymphoma. During the 2022 American Society of Hematology (ASH) Annual Meeting and Exposition (Abstract 607), the investigators presented their final analysis at the median follow-up of 12.3 years.

“We have shown that rituximab monotherapy is highly effective at deferring time to next-treatment in patients with asymptomatic low tumor burden follicular lymphoma, with rituximab maintenance being superior to [induction],” concluded the study authors. “Upfront rituximab should therefore be considered an effective treatment option for patients who wish to delay chemoimmunotherapy.”

A total of 463 patients with stage II–IV, asymptomatic, low tumor burden follicular lymphoma were enrolled in this study. Participants were randomly assigned to receive rituximab induction (n = 84) or rituximab induction with rituximab maintenance (n = 192) or to watch-and-wait status (n = 187).

The median time to next treatment was 2.7 years with observation and 9.9 years with rituximab induction; it was not reached with maintenance therapy but was significantly longer compared with induction therapy (P = .012). A second treatment was initiated in 75 participants.

The 25-month overall response rate for maintenance therapy was higher than for induction therapy (76.0% vs. 52.4%). Of note, the rate of disease progression was highest among those in the watch-and-wait arm (57.8%) compared with the rituximab induction (36.9%) and maintenance (15.1%) arms. Additionally, the 4-year progression-free survival rates for both treatment arms were superior to the observation arm, and the survival rate for the maintenance arm was superior to the induction arm (P < .001). There were no significant differences in overall survival, cause-specific survival, or high-grade transformations among all groups.

Disclosure: For full disclosures of the study authors, visit

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