Highlights

We have several choices [for first-line therapy], so you can either give them rituximab only, but it’s more typical if there is a treatment indication, you can combine a CD20 antibody with chemotherapy, so for example you could use obinutuzumab + bendamustine, or obinutuzumab + CHOP followed by obinutuzumab maintenance.

Roche has market approval for obinutuzumab based on the GALLIUM trial, and in the trial you can show that the progression-free survival is superior if you’re using obinutuzumab instead of rituximab, and it’s in our guidelines. So, for all patients in our hospital in first-line follicular lymphoma, if we’re choosing immunochemotherapy, we will use obinutuzumab + bendamustine, or obinutuzumab + CHOP.

There is data published that rituximab maintenance adds benefit in progression-free survival, maybe not overall survival, but there’s a significant benefit in progression-free survival. So, typically you are doing it for two years in first line, and also in relapsed disease. Actually, we have been doing it a lot, but now we have changed our policy here because of the COVID situation, and there’s the problem that if a patient has constant rituximab maintenance, we cannot vaccinate the patient, and therefore we have lifted that recommendation for now, so we are not starting new patients on rituximab maintenance because then we have this vaccination problem.