Re: Rituximab maintenance for the treatment of patients with follicular lymphoma: systematic review and meta-analysis of randomized trials.

Vidal et al. ( 1 ) reported on the use of rituximab maintenance for the treatment of follicular lymphoma. In contrast to their conclusions, we believe that there is insufficient evidence to routinely recommend maintenance rituximab following successful induction therapy in previously treated patients. In their meta-analysis, the authors pooled data from fi ve clinical trials of previously treated follicular lymphoma. They concluded that rituximab maintenance therapy, for up to 2 years, either as 4-weekly infusions every 6 months or as a single infusion every 2 – 3 months, should be added to standard therapy for patients with relapsed or refractory follicular lymphoma after successful induction treatment. As pointed out by the authors, this meta-analysis has several limitations, including the use of various induction regimens (chemotherapy alone, rituximab alone, and chemotherapy with or without rituximab) and multiple maintenance schedules. Although, in statistical sensitivity analyses, these differences did not alter the main results, the restricted sample size did not provide adequate statistical power to assess potential infl uences by different induction and postinduction treatments. Although Vidal et al. stated that the effect of rituximab maintenance therapy compared with rituximab at disease progression remains an open question in follicular lymphoma, they did not address this clinically important issue in the context of their own study. In one of the trials included in the meta-analysis, a study of 114 patients by Hainsworth et al. ( 2 ), patients in the control group were given rituximab at disease