Rituximab Maintenance: — Two More Years of Infusions, and Why

Skipping is not recommended. Feeling well is the maintenance working, not a sign you no longer need it. The two-year schedule is designed to sustain a continuous effect on remaining lymphoma cells, and unplanned gaps may allow cells that should be cleared to recover. If your team delays an infusion for a clinical reason such as low blood counts, that is managed as a short delay rather than a permanent skip — and your team will tell you when to come back.

You will not feel the maintenance working the way you felt induction chemotherapy. Response is assessed by restaging scans, typically at the end of the two years. Day to day, the absence of relapse symptoms — new lumps, night sweats, unexplained weight loss, worsening fatigue — is the indicator things are on track. Report any of those symptoms between infusions rather than waiting for your next scheduled appointment.

No. Hair loss during induction was caused by the chemotherapy drugs in that regimen, not by rituximab itself. Maintenance uses rituximab alone, without those chemotherapy agents. That is one of the main reasons most people find maintenance considerably easier to tolerate than the initial induction phase.

Yes, and your team monitors for this. Rituximab depletes B-cells over time, which lowers your immunoglobulin levels and reduces your antibody defence against infection. Your team will check these levels before each infusion. If levels fall to a point your team considers a risk, they may recommend immunoglobulin replacement. The practical step for you is to report any fever, any infection that is slow to clear, or any infection that comes back shortly after finishing antibiotics — rather than treating it yourself and waiting.

If there are signs of progression — new or enlarging lymph nodes, new symptoms, a rising LDH level — your team will investigate with a scan and possibly a biopsy. Maintenance would be stopped and your case reviewed. Relapse during maintenance does not mean you have run out of options. It means a different treatment strategy is needed, and your oncologist will explain what the evidence supports for your specific situation at that point.

Yes. Rituximab — sometimes known by the brand name MabThera — is the same drug used in your induction regimen. Maintenance gives it alone, without the accompanying chemotherapy agents. The dose is identical to what you received as part of R-CHOP, bendamustine-rituximab, or whichever regimen you had. Infusion reactions, if you experienced any during induction, remain possible at subsequent doses — which is why the nurse checks how you are feeling throughout every infusion, not just the first.