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Traitement de maintenance des lymphomes malins non hodgkiniens

Maintenance treatment of malignant non-Hodgkins lymphoma

  • Synthèse / Review Article
  • Published:
Oncologie

Abstract

Maintenance treatment aims to sustain the response of induction chemotherapy, reduce the relapse rate, and provide a longer progression-free survival and time to the next course of chemotherapy. It must have an acceptable toxicity profile in order to obtain the trust of both patient and physician over the long term; it must maintain the patient in remission. An ideal maintenance treatment would be effective as monotherapy, with minimal side effects in the short and long term, and easy to administer, requiring minimal supervision. Different drugs are used for non-hodgkin lymphoma, but the results are sometimes controversial; the first was interferon alpha, which is not a standard treatment. More recently, rituximab has demonstrated a significant improvement in progression-free survival, but no improvement in overall survival in the treatment of follicular NHL. The PRIMA study confirms this data: progression-free survival at 3 years was 75% (against 58% in the control arm). So, rituximab can be used as standard maintenance therapy. Other molecules are also developed for this purpose, such as enzastaurin and lenalidomide, for which we do not yet have a definitive evaluation.

Résumé

Le traitement de maintenance a pour objectifs de pérenniser la réponse après une chimiothérapie d’induction, de diminuer le taux de rechute, d’allonger la progression-free survival (PFS) ou survie sans progression. Il doit avoir un profil de toxicité acceptable afin d’obtenir une adhésion du patient et de son praticien sur le long terme, et maintenir le malade en rémission. Dans les lymphomes malins non hodgkiniens, différentes molécules sont utilisées avec des résultats divers; la première d’entre elles fut l’interféron alpha, dont l’utilisation délicate n’a pas permis d’en faire un standard de traitement. Plus récemment, le rituximab en maintenance a démontré une nette amélioration de la PFS, sans amélioration de l’overall survival (OS) ou survie globale dans le traitement du LMNH folliculaire. L’essai PRIMA confirme ses données: la PFS à trois ans est de 75 % (contre 58 % dans le bras témoin). Il permet de définir un standard de traitement du traitement de maintenance par rituximab. D’autres molécules sont développées également dans cet objectif comme l’enzastaurin, le lénalidomide, pour lesquelles nous ne disposons pas encore d’évaluation définitive.

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Authors and Affiliations

  1. Service d’hématologie, CHRU de Lille, hôpital Claude-Huriez, rue Michel-Polonovski, F-59037, Lille cedex, France

    L. Pascal, L. Terriou & F. Morschhauser

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  1. L. Pascal
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  2. L. Terriou
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  3. F. Morschhauser
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Correspondence to L. Pascal.

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Pascal, L., Terriou, L. & Morschhauser, F. Traitement de maintenance des lymphomes malins non hodgkiniens. Oncologie 13, 543–547 (2011). https://doi.org/10.1007/s10269-011-2062-4

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  • DOI: https://doi.org/10.1007/s10269-011-2062-4

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