Mabtera (rituximab) treatment of patients with refractory' course of B-cell lymphoma on high-dose chemotherapy with autologous transplantation of hemopoiesis precursor cells


Cite item

Full Text

Abstract

Aim. To study efficacy of htuximab in patients with resistant B-cell lymphoma on high-dose chemotherapy.
Material and methods. From September 2000 to April 2002 we studied efficacy and tolerance of rituximab at different stages of high-dose chemotherapy. The treatment was given to 10 patients with histologically verified CD20+ non-Hodgkln's lymphoma: diffuse large-cell (n = 4), Berkitfs (n = 2), follicular (n - 3), mantle-cell (n = 1). Five patients with diffuse large-cell lymphoma and Berkitt's lymphoma had a primary resistant course of the disease, one patient with diffuse large-cell lymphoma had a refractory recurrence. Follicular and mantle-cell lymphomas were characterized by a resistant course and large tumar masses. The patients received 1-2 courses of induction chemotherapy with dexa-BEAM with collection of peripheral stem cells followed by high-dose chemotherapy (BEAM-9, CBV+mitoxantron-1) with transplantation of autologous stem blood cells. Rituximab infusion (375 mg/m2) was conducted before the collection of the stem cells, prior to high-dose chemotherapy and in posttransplantation period after recovery of hemopoiesis.
Results. 4 patients achieved complete remission, 3 - partial remission, 2 had progression and 1 - stabilization. In mean follow-up 11 (2-20) months 7 of 10 patients were alive, overall survival being 15 + 2.4 months (95% confidence interval 10-19.7), median was not reached. 5patients are in complete remission: 2 of them without further treatment, 3 - after progression and repeat therapy including rituximab and interferon-a or rotuximab and CHOP chemotherapy.
Conclusion. The addition of rituximab can improve the results of high-dose chemotherapy of patients with non-Hodgkin's lymphoma resistant to standard doses of cytostatics. Repeat use of this drug can be effective in some patients with progression after high-dose chemotherapy with rituximab.

References

  1. Philip Т., Guglielmi С., Hagenbeek A. et al. Autologous bone marrow transplantation as compared with salvage chemotherapy in relapses of chemotherapy-sensitive non-Hodgkin's lymphoma [see comments]. N. Engl. J. Med. 1995; 33: 1540.
  2. Philip Т., Armitage J. O., Spitzer G. et al. High-dose therapy and autologous bone-marrow transplantation after failure of conventional chemotherapy in adults with intermediate-frade of high-frade non-Hodgkin's lymphoma. Ibid. 1987; 316: 1493.
  3. Blay J.-Y., Gomez F., Sebban С. et al. The International prognostic index correlates to survival in patients with agressive lymphoma in relapse: analysis of the PARMA trial. Blood 1998; 92(10): 3562-3568.
  4. Gallagher С. J., Gregory W. M., Jones A. E. et al. Follicular lymphoma: prognostic factors for response and survival. J. Clin. Oncol. 1986; 4(10): 1470-1480.
  5. Anderson K. C., Bates M. P., Slaughenhoupt В. L. et al. Expression of human B-cell associated antigens on leukemias and lymphomas: a model of human В cell differentiation. Blood 1984; 63: 1424-1433.
  6. Reff M. E., Carner K., Chambers K. S. et al. Depletion of В cells in vitro by chimeric mouse human monoclonal antibody to CD20. Ibid. 83: 435-445.
  7. Moloney D. G. et al. The anti-tumor effect of monoclonal antiCD20 antibody (mAb) therapy includes direct antiproliferative activity and induction of apoptosis in CD20 positive nonHodgkin's lymphoma (NHL) cell lines. Ibid. 1996; 88(suppl. 1): 647A, abstr. 2535.
  8. Moloney D. G., Liles T. M., Czerwinski D. K. et al. Phase I clinical trial using escalating single-dose infusion of climeric anti-CD20 monoclonal antibody (IDEC-C2B8) in patients with recurrent B-cell lymphoma. Ibid. 1994; 84: 2457-2466.
  9. Demidem A., Lam Т., Alas S. et al. Chimeric anti-CD20 (IDEC-C2B8) monoclonal antibody sensitizes а В cell lymphoma cell line to cell killing by cytotoxic drugs. Cancer Biother. Radiopharm. 1997; 12: 177.
  10. Coiffier В., Haioun C., Ketterer N. et al. Rituximab (anti-CD20 monoclonal antibody) for the treatment of patients with relapsing of refractory aggressive lymphoma a multicenter phase II study. Blood 1998; 92: 1927. /
  11. Vose J. M., Link B. K., Grossbard M. L. et al. Phase II study o/ rituximab in combination with CHOP chemotherapy in pa- tients with previously untreated, aggressive non-HodgkinV lymphoma (NHL). J. Clin. Oncol. 2001; 19: 389-397.
  12. Coiffier B. et al. MabThera (Rituximab) plus CHOP is stiperior to CHOP alone in elderly patients with diffuse large B-cell lymphoma (DLCL): interim results of a randomized GELA trial. Blood 2000; 95(suppl. 1): abstr. 950.
  13. Piro L. D., White С. A., Grille-Lopez A. J. et al. Extended rituximab (anti-CD20 monoclonal antibody) therapy for relapsed of reflectory low-grade or follicular non-Hodgkin's lymphoma. Ann. Oncol. 1999; 10: 619.
  14. Czuczman M. S.. Grillo-Lopez A. J., White C. A. et al. Treatment of patients with low-grade B-cell lymphoma with the combination of chimeric anti-CD20 monoclonal antibody and CHOP chemotherapy. J. Clin. Oncol. 1999; 17: 268.
  15. Davis T. A., Grillo-Lopez A. J., White С. A. et al. Rituximab anti-CD20 monoclonal antibody therapy in non-Hodgkin's lymphoma: safety and efficacy of re-treatment. Ibid. 2000; 18: 3135-3143.
  16. Buckstein R., Imrie K., Spaner D. et al. Stem cell function and engraftment is not affected by "in vivo purging" with rituximab for autogous stem cell treatment for patients with low-grade non-Hodgkin's lymphoma. Semin. Oncol. 1999; 5(suppl. 14): 115-122.
  17. Pan D. et al. Clinical outcome in patients treated with rituximab for relapse or refractory aggressive non-Hodgkin's lymphoma in post-transplant setting. Blood 2000; 96(suppl. 1): abstr. 1746.

Supplementary files

Supplementary Files
Action
1. JATS XML

Copyright (c) 2003 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 

Address of the Editorial Office:

  • Alabyan Street, 13/1, Moscow, 127055, Russian Federation

Correspondence address:

  • Alabyan Street, 13/1, Moscow, 127055, Russian Federation

Managing Editor:

  • Tel.: +7 (926) 905-41-26
  • E-mail: e.gorbacheva@ter-arkhiv.ru

 

© 2018-2021 "Consilium Medicum" Publishing house


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies