ArticleClinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico2026
Maintenance treatment and survival in patients with newly diagnosed diffuse large B cell lymphoma in the immunochemotherapy era: a systematic review and network meta-analysis.
Article in Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo assess the comparative efficacy of various maintenance strategies for patients with newly diagnosed diffuse large B cell lymphoma (DLBCL).
methodsWe conducted a comprehensive search of PubMed, Embase, Web of Science, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials for randomized clinical trials evaluating maintenance strategies in previously untreated DLBCL patients. The primary outcomes were progression-free survival (PFS) and overall survival (OS). The secondary outcomes were PFS at 24 months (PFS24) and Safety. A network meta-analysis using a random effects consistency model was performed to synthesize the evidence. No maintenance was used as the common comparator, and the effect of placebo was considered equivalent to no treatment.
resultsA total of ten trials involving 3830 patients and seven maintenance options were included. Significant PFS benefits were observed with lenalidomide (HR = 0.71, 95% CI = 0.53-0.94) and rituximab (HR = 0.77, 95% CI = 0.64-0.92) maintenance compared with no maintenance. No maintenance intervention significantly improved OS. However, our findings first demonstrated that rituximab maintenance treatment was significantly associated with improved PFS24 in previously untreated patients (RR = 1.06, 95% CI = 1.02-1.11). The quality of evidence was low because of incoherence, as assessed by the Confidence in Network Meta-Analysis (CINeMA) tool. Subgroup analysis revealed that rituximab maintenance was particularly beneficial for high-risk and male patients, with a potential OS benefit for male patients.
conclusionMaintenance therapy, particularly rituximab, provides a prognosis benefit for patients with previously untreated DLBCL. Specific subgroups, such as male patients, may derive additional benefits from maintenance therapy.
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