Rituximab affects the prognosis of patients with nonHodgkin' s lymphomas

Abstract

Background. Rituximab - the most widely used monoclonal antibody in the B cell lymphoid malignancies - has been applied successfully in the treatment of relapsed and refractory indolent CD20 positive B cell lymphomas and more recently, also in the treatment of aggressive lymphomas in combination with standard chemotherapy. Albeit the chemo-immunotherapy has a wide range of potential applications, there are still several issues that have to be resolved: (1) the optimal scheduling of antibody-chemotherapy combinations, (2) the most active of these combinations, as well as (3) the predictors of response to rituximab.

Patients and methods. To facilitate addressing the first two questions, we performed an analysis in 25 patients with different histological types of CD20 positive nonHodgkin's lymphomas (10 aggressive and 15 indolent). Seventeen patients were treated with chemo-immunotherapy for a relapse, and just in 8 patients rituximab was added to first line chemotherapy. Most of the responders received the CHOP regimen, but also other regimens (FC, BVCPP) were effective in combination with rituximab.

Results. The overall response rate was 76%, with 68% complete remissions. The median response duration has not been reached yet. The response was markedly better in the group of previously untreated patients, where the overall response rate reached 100%, with 7 patients in complete and 1 patient in partial remission. Most of the treatment failures occurred in heavily pretreated patients with aggressive lymphomas. No serious adverse effects were observed.

Conclusion. The chemo-immunotherapy improves the treatment outcomes in patients with untreated and relapsed CD20 positive nonHodgkin's lymphomas in comparison to chemotherapy alone. The combined treatment is the most effective when used as soon as possible (preferably as the first line treatment). To optimize the use of rituximab, not only the most active antibody-chemotherapy combination will have to be determined, but also the predictors of success of such treatment will have to be identified.