As a first-line treatment for patients with marginal zone lymphoma, the combination of bendamustine with rituximab (BR) conferred no advantage in overall survival over rituximab monotherapy, which can yield durable remissions with less toxicity, according to a study published in the journal Haematologica.
The researchers conducted a retrospective study using two large and independent real-world datasets: the US National Cancer Data Base (N= 5,068) and a multi-institutional dataset comprised of 878 MZL patients treated at ten centers in the United States between 2010 and 2020.
Across the two complementary real-world datasets, first-line BR and rituximab monotherapy produced comparable OS in MZL, with a five-year OS of 86.2% for BR recipients versus 87.2% for recipients of rituximab monotherapy.
In term of progression-free survival, however, the results showed that BR prolonged PFS by roughly 15% at five years. These results mirror the IELSG-19 phase 3 trial data, which found longer PFS but no OS benefit for rituximab-chlorambucil versus rituximab monotherapy.
“Our findings reinforce the concept that BR’s toxicity profile – prolonged cytopenias, immunosuppression, and potential for secondary myeloid malignancies – should be weighed against PFS extension,” the authors wrote, adding that rituximab maintenance or retreatment can prolong PFS, potentially reducing the need for upfront chemotherapy.
In patients with MZL, in whom relapses are often indolent and asymptomatic, PFS may not translate into meaningful survival or quality-of-life gains, the researchers noted.
“Given similar survival and greater toxicity with chemotherapy, treatment selection should incorporate patient preferences regarding quality of life, tolerance for treatment risks and burden,” the authors concluded. “Rituximab monotherapy remains a reasonable first-line standard and a platform for future combinations with targeted or biologic agents.”
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