Maintenance therapy
Maintenance therapy is sometimes given after an initial course of treatment has put lymphoma into remission. The most common treatment used as maintenance therapy for lymphoma are the antibody therapies rituximab and obinutuzumab.
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Who might have maintenance therapy?
What maintenance therapies are available for people with lymphoma?
What is maintenance therapy?
Maintenance therapy is treatment given after an initial course of treatment has put your lymphoma into remission (your lymphoma has shrunk or gone away completely). Maintenance therapy aims to make your remission last as long as possible, by keeping any lymphoma cells left in your body under control. It is often a long-term treatment that can last several years.
This is different to having long-term targeted treatments as a continuation of your main treatment.
Who might have maintenance therapy?
Maintenance therapy is currently recommended for:
- people with follicular lymphoma who are in remission after initial treatment with antibody therapy and chemotherapy
- people with mantle cell lymphoma who are in remission after initial treatment
- people with marginal zone lymphoma (MALT lymphoma, nodal marginal zone lymphoma or splenic marginal zone lymphoma) who are in remission after initial treatment.
People with other subtypes of low-grade non-Hodgkin lymphoma might also be offered maintenance treatment, although the benefits of this are less clear.
For people with these types of lymphoma, maintenance therapy can make remissions last longer and delay the need for more treatment. However, it isn’t suitable for everyone. Your lymphoma specialist should discuss the risks and benefits of maintenance therapy with you if they think it might be right for you.
What maintenance therapies are available for people with lymphoma?
Antibody therapy is the most common type of treatment used as maintenance therapy for people with lymphoma. At the time of writing, two antibody therapies are available for maintenance therapy: rituximab and obinutuzumab.
Chemotherapy is sometimes used as maintenance therapy for children or young people with lymphoblastic lymphoma, a type of non-Hodgkin lymphoma. This is a less intensive course of chemotherapy than the initial treatment. It is usually given as an outpatient treatment at regular intervals over a couple of years.
How is maintenance therapy given?
Rituximab
If you are having rituximab as maintenance therapy, you usually have it once every 2 months for 2 years. You have it in one of the following ways:
- As an injection just underneath your skin (subcutaneously). This takes a few minutes.
- Through a drip into a vein (intravenously). This takes a few hours.
With intravenous treatment, you have pre-medication first, to help prevent any reactions to the medicine. You might also have this if treatment is given subcutaneously.
Obinutuzumab
If you are having obinutuzumab maintenance therapy, you have it through a drip into a vein. You have pre-medication first, to help prevent any reactions to the medicine. You are then given obinutuzumab, which takes a few hours. You have obinutuzumab every 2 months for up to 2 years.
Living with maintenance therapy
Rituximab and obinutuzumab don’t usually cause serious side effects in most people. If given as an injection, you might get redness, soreness or swelling where the medicine went in. However, rituximab and obinutuzumab can sometimes cause severe reactions. They also increase your chance of getting an infection. If you have severe or repeated infections, your medical team might recommend stopping maintenance therapy.
If you are having rituximab or obinutuzumab maintenance therapy, you should not have any vaccines that are ‘live’. Live vaccines are made using weakened versions of living viruses or bacteria. They could cause serious infections in people who are on maintenance therapy.
You can have vaccines that are not live (also called ‘non-replicating’), although you might not respond to them as well as people who are not having maintenance therapy.