Rituximab Is Active in Lymphocyte-Predominant Hodgkin’s Disease

We designed a phase II trial to determine the efficacy of thechimeric anti-CD20 monoclonal antibody rituximab (Rituxan) inlymphocyte-predominant Hodgkin’s disease (LPHD). A unique subtype of Hodgkin’sdisease that expresses the CD20 antigen, LPHD has been historically andeffectively treated with radiotherapy and/or chemotherapy. However, a subset ofpatients experience recurrence, and significant treatment-related morbidity andmortality have been reported. Rituximab may not only be effective, but it mayalso cause fewer adverse late effects.

A total of 13 patients with LPHD received rituximab at 375 mg/m²weekly × 4. All tumors were CD20 positive and histologically andimmunohistochemically consistent with LPHD. The median age was 39 years (range:23 to 51 years), with nine males and five females. Eight patients had untreateddisease, classified as stage IA (2 patients),IIA (2), or IIIA (4). Five patients had recurrent disease after radiation (2patients), chemotherapy (2), and combined-modality treatment (1). Disease siteswere neck (4), axilla (7), mediastinum (1), iliac (5), inguinal/femoral (2), andspleen (1). Restaging studies were performed at 6 weeks, 3 months, 6 months, and12 months following therapy.

Of 9 evaluable patients, 6 had complete responses and 3 hadpartial responses (PR) at initial restaging. There has been one relapse at 6months. This patient was subsequently retreated with rituximab at 375 mg/m²weekly × 4, and has achieved a PR at 3-month follow-up. All 13 patientstolerated therapy well without grade 3 or 4 toxicities.

CONCLUSION: These preliminary results show that prompt tumorreduction with minimal toxicity can be achieved with rituximab in LPHD. Furtherfollow-up and study is warranted to establish the durability of response andoverall impact of this novel therapeutic approach.

Click here to read Dr. Bruce Cheson's commentary on this abstract.