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Rituximab Post-transplant Improves Survival in B-Cell NHL

Rituximab Post-transplant Improves Survival in B-Cell NHL

ORLANDO—Giving rituximab (Rituxan) after high-dose chemotherapy/autologous
peripheral blood stem cell transplantation for B-cell non-Hodgkin’s lymphoma
(NHL) produced better survival and freedom from progression rates than would be
expected with a conventional transplant regimen, according to a phase II study
reported at the 43rd Annual Meeting of the American Society of Hematology
(abstract 3578).

The rationale for the study was the 40% to 60% relapse rate among patients
receiving high-dose therapy/stem cell transplant, said Steven M. Horwitz, MD,
of Stanford University. Since most B-cell NHL patients express the CD20
antigen, rituximab was considered an excellent candidate for adjuvant therapy
in the post-transplant setting.

Study Design

The study involved 35 patients with B-cell NHL undergoing high-dose
therapy/transplant. Most patients (25) had diffuse large cell NHL, but 3 had
mantle cell lymphoma, 3 had transformation of low-grade lymphoma, and 4 had
other B-cell lymphomas.

As a preparative regimen, 32 patients received carmustine (BiCNU),
cyclophosphamide, and etoposide, and 3 had total-body irradiation. All received
a purged stem cell product.

The first four patients received four weekly transfusions of rituximab at a
dose of 375 mg/m² starting 40 days after transplant. The other 31 patients
received that plus an additional 4-week course of rituximab at 6 months.

Among the 35 patients enrolled, 29 completed all planned therapy. Six
patients received less rituximab than planned due to neutropenia, hypotension,
disseminated zoster, relapse, or death. At a median follow-up of 18 months,
four patients had died and four had relapsed.

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