Progressive Intermediate Grade Non-Hodgkin’s LymphomaAfter High-Dose Therapy and Autologous Peripheral Stem-Cell Transplantation Has a High Response Rate to Rituximab

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Article
OncologyONCOLOGY Vol 13 No 3
Volume 13
Issue 3

Rituximab (Rituxan) is active in low-grade non-Hodgkin’s lymphoma (NHL), but its efficacy in poor-prognosis intermediate-grade NHL is unknown. To address this issue, we administered rituximab to seven patients with CD20-positive diffuse large cell NHL who had progressive disease despite high-dose therapy and peripheral stem-cell transplantation (PSCT). The median age was 59 years (range, 45-62 years) with ECOG performance status 0-1. Prior to rituximab therapy, all patients had undergone PSCT, with responses of two complete responses (CRs), two partial responses (PRs), one patient with stable disease (SD), and two patients with progressive disease (PD). The CRs lasted 9 and 11 months. Upon relapse or progression of disease, the patients received 4 weekly infusions of rituximab (375 mg/m²).

Rituximab (Rituxan) is active in low-grade non-Hodgkin’s lymphoma (NHL), but its efficacy in poor-prognosis intermediate-grade NHL is unknown. To address this issue, we administered rituximab to seven patients with CD20-positive diffuse large cell NHL who had progressive disease despite high-dose therapy and peripheral stem-cell transplantation (PSCT). The median age was 59 years (range, 45-62 years) with ECOG performance status 0-1. Prior to rituximab therapy, all patients had undergone PSCT, with responses of two complete responses (CRs), two partial responses (PRs), one patient with stable disease (SD), and two patients with progressive disease (PD). The CRs lasted 9 and 11 months. Upon relapse or progression of disease, the patients received 4 weekly infusions of rituximab (375 mg/m²).

Acute complications consisted of rash and rigors in one patient during the first infusion only. Delayed adverse events included three episodes of transient granulocytopenia (absolute neutrophil count [ANC] nadir, 48, 644, and 1,394), occurring from day 74 to day 112, resulting in one hospitalization for neutropenic fever.

Of the five patients who were initially symptomatic from their NHL, two had complete resolution of and three had improvement in their symptoms by the completion of the 4-week course. At initial restaging (day 48-79) after initiation of therapy, 6 of 7 patients responded (1 CR and 5 PRs) and one patient had SD. Two patients (1 SD and 1 PR) later developed progressive disease at day +60 and +87, respectively, and underwent retreatment with rituximab, with responses of CR and PD, respectively. Maximum response achieved was 3 CRs and 4 PRs. Six of seven patients achieved a performance status of 0. With median follow-up of 215 days (range, 117-270 days) from initiation of therapy, and with 2 patients having undergone retreatment, there currently are 2 CRs, 2 PRs, and 3 patients with PD (mixed response). The incidence of granulocytopenia, while significantly higher than that seen with rituximab in low-grade NHL, was transient and lower than that expected with conventional salvage chemotherapy.

CONCLUSION: Rituximab appears to have significant activity and is well tolerated in patients with progressive intermediate-grade NHL after PSCT.

Click here for Dr. Bruce Cheson’s commentary on this abstract.

Articles in this issue

WHO Declares Lymphatic Mapping to Be the Standard of Care for Melanoma
Rituximab: Phase II Retreatment Study in Patients With Low-Grade or Follicular Non-Hodgkin’s Lymphoma
Response Criteria for NHL: Importance of “Normal” Lymph Node Size and Correlations With Response
Chemotherapy Plus Radiation Improves Survival in Patients With Cervical Cancer
A Randomized Trial of Fludarabine, Mitoxantrone (FM) Versus Doxorubicin, Cyclophosphamide, Vindesine, Prednisone (CHEP) as First Line Treatment in Patients With Advanced Low-Grade Non-Hodgkin's Lymphoma: A Multicenter Study by GOELAMS Group
Navelbine Increased Elderly Lung Cancer Patients’ Survival
Fludarabine Versus Conventional CVP Chemotherapy in Newly C Diagnosed Patients With Stages III and IV Low-Grade Malignant Non-Hodgkin’s Lymphoma: Preliminary Results From a Prospective, Randomized Phase III Clinical Trial in 381 Patients
Multicenter, Phase III Study of Iodine-131 Tositumomab (Anti-B1 Antibody) for Chemotherapy-Refractory Low-Grade or Transformed Low-Grade Non-Hodgkin’s Lymphoma
T-Cell–Depleted Allogeneic Bone Marrow Transplant From HLA-Matched Sibling Donors for Non-Hodgkin’s Lymphoma
Consensus Statement on Prevention and Early Diagnosis of Lung Cancer
In Vivo Purging and Adjuvant Immunotherapy With Rituximab During PBSC Transplant For NHL
Fludarabine and Cyclophosphamide: A Highly Active and Well-Tolerated Regimen for Patients With Previously Untreated Indolent Lymphomas
Campath-1H Monoclonal Antibody in Therapy for Advanced Low-Grade Non-Hodgkin’s Lymphomas: A Phase II Study
AIDS Drugs Effective Against Most Common HIV Strain
Rituximab Therapy in Previously Treated Waldenström’s Macroglobulinemia: Preliminary Evidence of Activity
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