of rituxi-mab (Rituxan) in lymphocyte-predominant Hodgkin’s disease (LPHD)
warrants additional investigation, according to a presentation at the 38th
Annual Meeting of the American Society of Clinical Oncology (abstract 1052).
"Rituximab appears to have some activity in patients with
LPHD, but the duration of response is quite short, and two cases transformed to
large-cell non-Hodgkin’s lymphoma, so there is some debate about whether it is
an appropriate therapy," lead author Bradley C. Ekstrand, MD, PhD, senior
oncology fellow, Stanford University Medical Center, told ONI in an
interview. "It will require a lot more investigation."
Lymphocyte-predominant Hodgkin’s disease is rare,
constituting only 5% of all Hodgkin’s disease cases, and misdiagnosis is common
because pathologic features may be similar to those of other types of Hodgkin’s
disease. Although LPHD is typically relatively indolent and limited to the
lymph nodes, it represents a therapeutic challenge.
"With the standard therapy of radiation therapy and
chemotherapy, 96% of patients have a complete response, but they tend to
relapse over time, with relapses continuing up to 20 years after remission,"
Dr. Ekstrand said. "Significant late effects of therapy include secondary
The rationale for using the anti-CD20 antibody rituximab is
that the malignant cells of LPHD are CD20 positive, and therefore rituximab may
have activity with fewer adverse late effects than conventional chemotherapy.
In this phase II trial, 22 patients with either untreated or
relapsed CD20-positive LPHD and measurable disease on CT scans received four
consecutive weekly doses of rituximab at 375 mg/m2.
Patients who had previously received rituximab were excluded, and steroid
treatment during the study period was prohibited.
Median age at treatment was 45 years (range, 18 to 61
years). Of 10 previously treated patients, six were in their first relapse,
three in their second relapse, and one in fourth relapse. Three had relapsed
after chemotherapy alone, three after radiotherapy alone, and four after
combined modality treatment. Median duration of remission before receiving
rituximab was 9 years. Of 12 patients with untreated disease, 6 were stage I or
II, and 6 were stage III.