Skip to main content

Loss of CD20 antigen expression after rituximab therapy of CD20 positive B cell lymphoma (diffuse large B cell extranodal marginal zone lymphoma combination): A case report and review of the literature

Medical Oncology volume 29, pages 1223–1226 (2012)Cite this article

Abstract

Rituximab (the chimeric anti-CD20 antibody) is widely used in the treatment of CD20 positive non-Hodgkin’s lymphoma (NHL). The response rate at relapse after repeated use in prior CD20 positive responders is lower than 50%. Several mechanisms can be responsible for rituximab resistance. CD20 negative relapses which transformed from CD20 positive aggressive and indolent forms of lymphoma can be the one of the reason of secondary resistance to rituximab. The authors report a case with combination of aggressive and indolent form of lymphoma who relapsed after 7 months from the last dose of rituximab therapy. CD20 transformed negative from positive in her relapsed disease. Patients with CD20 positive B cell NHL must rebiopsy after first line rituximab therapy if their disease relapsed or progressed.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Smith MR. Rituximab (monoclonal anti-CD20 antibody): mechanisms of action and resistance. Oncogene. 2003;22:7359–68.

    PubMed  Article  CAS  Google Scholar 

  2. Davis TA, Grillo-Lopez AJ, White CA, McLaughlin P, Czucman MS, Link BK, Maloney DG, Weaver RL, Rosenberg J, Levy R. Rituximab anti-CD20 monoclonal antibody therapy in non-Hodgkin’s lymphoma: safety and efficacy of re-treatment. J Clin Oncol. 2000;18:3135–43.

    PubMed  CAS  Google Scholar 

  3. Kinoshita T, Nagai H, Murate T, Saito H. CD20 negative relapse in B-cell lymphoma after treatment with rituximab. J Clin Oncol. 1998;16:3916.

    PubMed  CAS  Google Scholar 

  4. Grillo-Lopez AJ, Kunkel L. Therapy of B-cell lymphoma with anti-CD20 antibodies can result in loss of CD20 antigen expression. Clin Cancer Res. 2000;6:317–8.

    PubMed  CAS  Google Scholar 

  5. Schmitz K, Brugger W, Weis B, Kaiserling E, Kanz L. Clonal selection of CD20 negative non Hodgkin’s lymphoma cells after treatment with anti CD20 antibody rituximab. Br J Haematol. 1999;106:571–2.

    PubMed  Article  CAS  Google Scholar 

  6. Foran JM, Norton AJ, Micallef IN, Taussıg DC, Amess JA, Rohatıner AZ, Lister TA. Loss of CD20 expression following treatment with rituximab (chimeric monoclonal chimeric anti CD20): a retrospective cohort analysis. Br J Haematol. 2001;114:881–3.

    PubMed  Article  CAS  Google Scholar 

  7. Kennedy GA, Tey SK, Cobcroft R, Marlton P, Cull G, Grimmett K, Gill D. Incidence and nature of CD20-negative relapses following rituximab therapy in aggressive B-cell non-Hodgkin’s lymphoma: a retrospective review. Br J Haematol. 2002;119:412–6.

    PubMed  Article  CAS  Google Scholar 

  8. Alvaro-Naranjo T, Jaen-Martinez J, Guma-Pardro J, Bosch-Princep R, Salvado-Usach MT. CD20-negative DLBCL transformation after rituximab treatment in follicular lymphoma: a new case report and review of literature. Ann Hematol. 2003;82:585–8.

    PubMed  Article  CAS  Google Scholar 

  9. Tomita A, Hiraga J, Kiyoi H, Ninomiya M, Sugimoto T, Ito M, et al. Epigenetic regulation of CD20 protein expression in a novel B-cell lymphoma cell line, RRBL1, established from a patient treated repeatedly with rituximab-containing chemotherapy. Int J Hematol. 2007;86:49–57.

    PubMed  Article  CAS  Google Scholar 

  10. Terui Y, Sakurai T, Mishima Y, et al. Identification of CD20 mutations in malignant lymphoma: can they be predictors of response to rituximab? Blood. 2005;106:288–9.

    Google Scholar 

  11. Sonoki T, Li Y, Miyanishi S, Nakamine H, et al. Establishment of a novel CD20 negative mature B-cell line, WILL2, from a CD20 positive diffuse large B-cell lymphoma patient treated with rituximab. Int J Hematol. 2009;89(3):400–2.

    PubMed  Article  Google Scholar 

  12. Berinstein N, Grillo-Lopez A, White C, BenceBruckler I, Maloney D, et al. Rituximab (ICEC-C2B8) concentration and anti-tumor response in the treatment of recurrent low-grade or follicular non-Hodgkin’s lymphoma. Ann Oncol. 1998;9:995–1001.

    PubMed  Article  CAS  Google Scholar 

  13. Gisselbrecht C, Glass B, Mounier N, Singh Gill D, Linch DC, Trneny M, Bosly A, Ketterer N, Shpilberg O, Hagberg H, Ma D, Brière J, Moskowitz CH, Schmitz N. Salvage regimens with autologous transplantation for relapsed large B-cell lymphoma in the rituximab era. J Clin Oncol. 2010;28(27):4184–90.

    PubMed  Article  Google Scholar 

  14. Coiffier B, Haioun C, Ketterer N, et al. Rituximab (anti-CD20 monoclonal antibody) for the treatment of patients with relapsing or refractory aggressive lymphoma: a multicenter phase II study. Blood. 1998;92:1927–32.

    PubMed  CAS  Google Scholar 

  15. Igarashi T, Itoh K, Kobayashi Y, et al. Phase II and pharmacokinetic study of rituximab with eight weekly infusions in relapsed aggressive B-cell non-Hodgkin’s lymphoma (B-NHL). Prog Proc Am Soc Clin Oncol. 2002;21:1286.

    Google Scholar 

  16. Kewalramani T, Zelenetz AD, Nimer SD, Portlock C, Straus D, Noy A, O’Connor O, Filippa DA, Teruya-Feldstein J, Gencarelli A, Qin J, Waxman A, Yahalom J, Moskowitz CH. Rituximab and ICE as second-line therapy before autologous stem cell transplantation for relapsed or primary refractory diffuse large B-cell lymphoma. Blood. 2004;103(10):3684–8.

    PubMed  Article  CAS  Google Scholar 

  17. Amar-Maman D, Mounier N, Manson J, et al. Evaluation of efficacy and toxicity of rituximab plus aracytin–platinum(R-DHAP) regimen in non Hodgkin lymphoma (NHL) relapsing patients. Blood. 2002;100:293a.

    Google Scholar 

  18. Johnston A, Bouafia-Sauvy F, Broussais-Guillaumot F, Michallet AS, Traullé C, Salles G, Coiffier B. Retreatment with rituximab in 178 patients with relapsed and refractory B-cell lymphomas: a single institution case control study. Leuk Lymphoma. 2010;51(3):399–405.

    PubMed  Article  CAS  Google Scholar 

Download references

Author information

Affiliations

  1. Department of Medical Oncology, Çukurova University Medical Faculty, Adana, Turkey

    Berna Bozkurt Duman & Berksoy Şahin

  2. Department of Pathology, Cukurova University Medical Faculty, Adana, Turkey

    Melek Ergin

  3. Department of Hematology, Cukurova University Medical Faculty, Adana, Turkey

    Birol Guvenc

Authors
  1. Berna Bozkurt Duman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Berksoy Şahin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Melek Ergin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Birol Guvenc
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Berna Bozkurt Duman.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Duman, B.B., Şahin, B., Ergin, M. et al. Loss of CD20 antigen expression after rituximab therapy of CD20 positive B cell lymphoma (diffuse large B cell extranodal marginal zone lymphoma combination): A case report and review of the literature. Med Oncol 29, 1223–1226 (2012). https://doi.org/10.1007/s12032-011-9955-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12032-011-9955-3

Keywords

  • Rituximab
  • CD20
  • Lymphoma
  • Resistance