Maintenance therapy is a long-term treatment that usually lasts several years. It is sometimes 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 keep any lymphoma cells that might be left in your body under control. This helps make your remission last as long as possible.
Some targeted treatments are also given long-term – sometimes for as long as you continue to benefit from them. However, this is a continuation of your main treatment and is not the same as 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 high-dose chemotherapy and a stem cell transplant
- people with mantle cell lymphoma who are in remission after initial treatment with antibody therapy and chemotherapy, and who aren’t able to have a stem cell transplant.
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.
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 is available as maintenance therapy for adults with follicular lymphoma, mantle cell lymphoma and some other forms of low-grade non-Hodgkin lymphoma.
- Obinutuzumab is available as maintenance therapy for adults with follicular lymphoma.
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 course of initial treatment. It is usually given as an outpatient at regular intervals over a couple of years.
If you are having rituximab as maintenance therapy, you have it once every 2 to 3 months, usually 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 and is the most common way of having rituximab maintenance therapy.
- 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.
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.
Rituximab and obinutuzumab don’t usually cause serious side effects in most people. 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. There is emerging evidence that ongoing or recent rituximab lowers the effectiveness of the COVID-19 vaccination – speak to your medical team for advice.