1152 www.thelancet.com Vol 377 April 2, 2011 2 Vidal L, Gafter-Gvili A, Leibovici L, et al. Rituximab maintenance for the treatment of patients with follicular lymphoma: systematic review and meta-analysis of randomized trials. J Natl Cancer Inst 2009; 101: 248–55. 3 Vidal L, Gafter-Gvili A, Salles G, et al. Rituximab maintenance for the treatment of patients with follicular lymphoma: systematic review and meta-analysis of randomized trials—2010 update. Blood 2010; 116: 1798. 4 Salles G, Seymour JF, Off ner F, et al. Rituximab maintenance for 2 years in patients with high tumour burden follicular lymphoma responding to rituximab plus chemotherapy (PRIMA): a phase 3, randomised controlled trial. Lancet 2011; 377: 42–51. QoL benefi t of rituximab maintenance in reducing lymphoma recurrence. The similar QoL indices between the two study groups then simply indicates that rituximab maintenance does not diminish patients’ QoL despite a higher number of adverse events. Also, only 19 patients (4%) withdrew from maintenance because of toxic eff ects. This higher frequency of adverse events (particularly infections) during maintenance should not be overlooked, but was easily managed in most patients. Finally, we are not aware of any data to indicate that deferring rituximab therapy is of benefi t for patients with follicular lymphoma. On the basis of available evidence, rituximab maintenance in patients with hightumour-burden follicular lymphoma who respond to chemotherapy plus rituximab constitutes one of the most well-grounded options in fi rst-line management.
B. Hou, Zhiwei Xu, Lai-shuan Wang