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Spotlight on Rituximab in Non-Hodgkin’s Lymphoma and Chronic Lymphocytic Leukemia

  • Adis Spotlight
  • Published:
American Journal of Cancer

Abstract

Rituximab is an anti-CD20 monoclonal antibody that has demonstrated efficacy in patients with various lymphoid malignancies, including indolent and aggressive forms of B-cell non-Hodgkin’s lymphoma (NHL) and B-cell chronic lymphocytic leukemia (CLL). While the optimal use of the drug in many clinical settings has yet to be clarified, two pivotal trials have established rituximab as a viable treatment option in patients with relapsed or refractory indolent NHL, and as a standard first-line treatment option when combined with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy in elderly patients with diffuse large B-cell lymphoma (the most common type of aggressive NHL). The former was a noncomparative trial in relapsed indolent NHL (follicular and small lymphocytic subtypes) with clinical responses achieved in about half of patients treated with rituximab 375 mg/m2 intravenously once weekly for 4 weeks, which was similar to some of the most encouraging results reported with traditional chemotherapeutic agents. The latter was a randomized comparison of eight cycles of CHOP plus rituximab 375 mg/m2 intravenously (one dose per cycle) versus CHOP alone in previously untreated elderly patients (60 to 80 years of age) with diffuse large B-cell lymphoma. In this pivotal trial, 2-year event-free and overall survival were significantly higher with rituximab plus CHOP, and there was no increase in clinically significant adverse effects compared with CHOP alone.

Treatment with rituximab is generally well tolerated, particularly in terms of adverse hematological effects and serious or opportunistic infections relative to standard chemotherapy. Infusion-related reactions occur in the majority of patients treated with rituximab; these are usually mild to moderate flu-like symptoms that decrease in frequency with subsequent infusions. In approximately 10% of patients, however, severe infusion-related reactions develop (e.g. bronchospasm, hypotension). These reactions are usually reversible with appropriate interventions and supportive care but there have been rare reports of fatalities.

Conclusion: Clinical trials with rituximab indicate that the drug has broad application to B-cell malignancies, although further clarification is needed to determine its optimal use in many of these clinical settings. Importantly, rituximab in combination with CHOP chemotherapy has emerged as a new treatment standard for previously untreated diffuse large B-cell lymphoma, at least in elderly patients. Compared with conventional chemotherapy, rituximab is associated with markedly reduced hematological events such as severe neutropenia, as well as associated infections. Rituximab may be particularly suitable for elderly patients or those with poor performance status, and its tolerability profile facilitates its use in combination with cytotoxic drugs.

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References

  1. 2002 Mosby’s drag consult update 4: rituximab [online]. Available from URL: http://http://www.mosbysgenrx.com [Accessed 2002 Sep 20]

  2. Onrust SV, Lamb HM, Balfour JA. Rituximab. Drugs 1999; 58: 79–88

    Article  PubMed  CAS  Google Scholar 

  3. Grillo-López AJ, Hedrick E, Rashford M, et al. Rituximab: ongoing and future clinical development. Semin Oncol 2002 Feb; 29(1 Suppl. 2): 105–12

    Article  PubMed  Google Scholar 

  4. Maloney DG, Liles TM, Czerwinski DK, et al. Phase I clinical trial using escalating single-dose infusion of chimeric anti-CD20 monoclonal antibody (IDEC-C2B8) in patients with recurrent B-cell lymphoma. Blood 1994; 84: 2457–66

    PubMed  CAS  Google Scholar 

  5. McLaughlin P, Grillo-López AJ, Link BK, et al. Rituximab chimeric anti-CD20 monoclonal antibody therapy for relapsed indolent lymphoma: half of patients respond to a four-dose treatment program. J Clin Oncol 1998; 16: 2825–33

    PubMed  CAS  Google Scholar 

  6. Reff ME, Carner K, Chambers KS, et al. Depletion of B cells in vivo by a chimeric mouse human monoclonal antibody to CD20. Blood 1994; 83(2): 435–45

    PubMed  CAS  Google Scholar 

  7. Anderson KC, Bates MP, Slaughenhoupt BL, et al. Expression of human B cell-associated antigens on leukemias and lymphomas: a model of human B cell differentiation. Blood 1984; 63: 1424–33

    PubMed  CAS  Google Scholar 

  8. Demidem A, Lam T, Alas S, et al. Chimeric anti-CD20 (IDEC-C2B8) monoclonal antibody sensitizes a B cell lymphoma cell line to cell killing by cytotoxic drugs. Cancer Biother Radiopharm 1997; 12(3): 177–86

    Article  PubMed  CAS  Google Scholar 

  9. Nadler LM, Ritz J, Hardy R, et al. A unique cell surface antigen identifying lymphoid malignancies of B cell origin. J Clin Invest 1981; 67: 134–40

    Article  PubMed  CAS  Google Scholar 

  10. Almasri NM, Duque RE, Iturraspe J, et al. Reduced expression of CD20 antigen as a characteristic marker for chronic lymphocytic leukemia. Am J Hematol 1992; 40: 259–63

    Article  PubMed  CAS  Google Scholar 

  11. Petryk M, Grossbard ML. Rituximab therapy of B-cell neoplasms. Clin Lymphoma 2000 Dec; 1(3): 186–94; discussion 195-6

    Article  PubMed  CAS  Google Scholar 

  12. Gazzano-Santoro H, Ralph P, Ryskamp TC, et al. A non-radioactive complement-dependent cytotoxicity assay for anti-CD20 monoclonal antibody. J Immunol Methods 1997; 202: 163–71

    Article  PubMed  CAS  Google Scholar 

  13. Harjunpää A, Junnikkala S, Meri S. Rituximab (anti-CD20) therapy of B-cell lymphomas: direct complement killing is superior to cellular effector mechanisms. Scand J Immunol 2000; 51(6): 634–41

    Article  PubMed  Google Scholar 

  14. Golay J, Zaffaroni L, Vaccari T, et al. Biologic response of B lymphoma cells to anti-CD20 monoclonal antibody rituximab in vitro: CD55 and CD59 regulate complement-mediated cell lysis. Blood 2000 Jun 15; 95(12): 3900–8

    PubMed  CAS  Google Scholar 

  15. Flieger D, Renoth S, Beier I, et al. Mechanism of cytotoxicity induced by chimeric mouse human monoclonal antibody IDEC-C2B8 in CD20-expressing lymphoma cell lines. Cell Immunol 2000; 204: 55–63

    Article  PubMed  CAS  Google Scholar 

  16. Ghetie M-A, Bright H, Vitetta ES. Homodimers but not monmers of rituxan (chimeric anti-CD20) induce apoptosis in human B-lymphoma cells and synergize with a chemotherapeutic agent and an immunotoxin. Blood 2001 Mar 1; 97(5): 1392–8

    Article  PubMed  CAS  Google Scholar 

  17. Hofmeister JK, Cooney D, Coggeshall KM. Clustered CD20 induced apoptosis: Src-family kinase, the proximal regulator of tyrosine phosphorylation, calcium influx, and caspase 3-dependent apoptosis. Blood Cells Mol Dis 2000 Apr; 26(2): 133–43

    Article  PubMed  CAS  Google Scholar 

  18. Shan D, Ledbetter JA, Press OW. Signaling events involved in anti-CD20-induced apoptosis of malignant human B cells. Cancer Immunol Immunother 2000; 48(12): 673–83

    Article  PubMed  CAS  Google Scholar 

  19. Mathas S, Rickers A, Bommert K, et al. Anti-CD20- and B-cell receptor-mediated apoptosis: evidence for shared intracellular signaling pathways. Cancer Res 2000 Dec 15; 60: 7170–6

    PubMed  CAS  Google Scholar 

  20. Alas S, Emmanouilides C, Bonavida B. Inhibition of interleukin 10 by rituximab results in down-regulation of Bcl-2 and sensitization of B-cell non-Hodgkin’s lymphoma to apoptosis. Clin Cancer Res 2001 Mar; 7: 709–23

    PubMed  CAS  Google Scholar 

  21. Chow KU, Sommerlad WD, Boehrer S, et al. Anti-CD20 antibody (IDEC-C2B8, rituximab) enhances efficacy of cytotoxic drugs on neoplastic lymphocytes in vitro: role of cytokines, complement, and caspases. Haematologica 2002 Jan; 87(1): 33–43

    PubMed  CAS  Google Scholar 

  22. Taji H, Kagami Y, Okada Y, et al. Growth inhibition of CD20-positive B lymphoma cell lines by IDEC-C2B8 anti-CD20 monoclonal antibody. Jpn J Cancer Res 1998; 89: 748–56

    Article  PubMed  CAS  Google Scholar 

  23. Alas S, Bonavida B, Emmanouilides C. Potentiation of fludarabine cytotoxicity on non-Hodgkin’s lymphoma by pentoxifylline and rituximab. Anticancer Res 2000; 20: 2961–6

    PubMed  CAS  Google Scholar 

  24. Alas S, Ng C-P, Bonavida B. Rituximab modifies the cisplatin-mitochondrial signaling pathway, resulting in apoptosis in cisplatin-resistant non-Hodgkin’s lymphoma. Clin Cancer Res 2002 Mar; 8(3): 836–45

    PubMed  CAS  Google Scholar 

  25. MabThera: summary of product characteristics [online]. Available from URL: http://www.emea.eu.int [Accessed 2002 sep5]

  26. Berinstein NL, Grillo-López AJ, White CA, et al.association tuximab (IDEC-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

    Article  PubMed  CAS  Google Scholar 

  27. Maloney DG, Grillo-López AJ, Bodkin DJ, etal. IDEC-C2B8: results of a phase I multiple-dose trial in patients with relapsed non-Hodgkin’s lymphoma. J Clin Oncol 1997; 15: 3266–74

    PubMed  CAS  Google Scholar 

  28. Piro LD, White CA, Grillo-López AJ, et al. Extended rituximab (anti-CD20 monoclonal antibody) therapy for relapsed or refractory low-grade or follicular non-Hodgkin’s lymphoma. Ann Oncol 1999; 10(6): 655–61

    Article  PubMed  CAS  Google Scholar 

  29. Maloney DG, Grillo-López AJ, White CA, et al. IDEC-C2B8 (rituximab) anti-CD20 monoclonal antibody therapy in patients with relapsed low-grade non-Hodgkin’s lymphoma. Blood 1997; 90: 2188–95

    PubMed  CAS  Google Scholar 

  30. Coiffier B, Lepage E, Brière J, et al. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med 2002 Jan 24; 346: 235–42

    Article  PubMed  CAS  Google Scholar 

  31. Igarashi T, Kobayashi Y, Ogura M, et al. Factors affecting toxicity, response and progression-free survival in relapsed patients with indolent B-cell lymphoma and mantle cell lymphoma treated with rituximab: a Japanese phase II study. Ann Oncol 2002 Jun; 13(6): 928–43

    Article  PubMed  CAS  Google Scholar 

  32. Investigational data from randomized study of extended therapy with Rituxan demonstrates potential to delay disease progression in patients with indolent NHL [online]. Available from URL: http://http://www.ihmf.org/journal/ [Accessed 2002 Jun 25]

  33. Ghielmini M, Schmitz S-FH, Cogliatti S, et al. Prolonged treatment with rituximab significantly improves event free survival and duration of response in patients with follicular lymphoma: a randomised SAKK trial [abstract 604; online]. Available from URL: http://http://www.hematology.org/meeting/abstracts.cfm [Accessed 2002 Dec 10]

  34. Cortes-Funes H, de la Serna J, Flores E, et al. Rituximab immunotherapy in patients with relapsed follicular or low grade B-cell non-Hodgkin’s lymphoma; results after a six month follow-up cut-off [abstract 114]. 36th Annual Meeting of the American Society of Clinical Oncology; 2000 May 20–23; New Orleans (LA). Proc Am Soc Clin Oncol 2000; 19: 31a

    Google Scholar 

  35. FeuringBuske M, Kneba M, Unterhalt M, et al. IDEC-C2B8 (rituximab) anti-CD20 antibody treatment in relapsed advanced-stage follicular lymphomas: results of a phase-II study of the German Low-Grade Lymphoma Study Group. Ann Hematol 2000 Sep; 79: 493–500

    Article  CAS  Google Scholar 

  36. Foran JM, Gupta RK, Cunningham D, et al. A UK multicentre phase II study of rituximab (chimaeric anti-CD20 monoclonal antibody) in patients with follicular lymphoma, with PCR monitoring of molecular response. Br J Haematology 2000; 109: 81–8

    Article  CAS  Google Scholar 

  37. Davis TA, Grillo-López AJ, White CA, et al. Rituximab anti-CD20 monoclonal antibody therapy in non-Hodgkin’s lymphoma: safety and efficacy of retreatment. J Clin Oncol 2000 Sep; 18: 3135–43

    PubMed  CAS  Google Scholar 

  38. Davis TA, White CA, Grillo-López AJ, et al. Single-agent monoclonal antibody efficacy in bulky non-Hodgkin’s lymphoma: results of a phase II trial of rituximab. J Clin Oncol 1999; 17: 1851–7

    PubMed  CAS  Google Scholar 

  39. Witzig TE, Vukov AM, Habermann TM, et al. Rituximab therapy for patients with newly diagnosed, asymptomatic advanced-stage follicular grade I non-Hodgkin’s lymphoma (NHL): a phase II trial in the North Central Cancer Treatment Group (NCCTG) [online]. Available from URL: http://http://www.hematology.org/meetting/abstracts.cfm [Accessed 2002 Dec 10]

  40. Colombat P, Salles G, Brousse N, et al. Rituximab (anti-CD20 monoclonal antibody) as single first-line therapy for patients with follicular lymphoma with a low tumor burden: clinical and molecular evaluation. Blood 2001 Jan 1; 97: 101–6

    Article  PubMed  CAS  Google Scholar 

  41. Hainsworth JD, Litchy S, Burris III HA, et al. Rituximab as first-line and maintenance therapy for patients with indolent non-Hodgkin’s lymphoma. J Clin Oncol 2002; 20(20): 4261–7

    Article  PubMed  CAS  Google Scholar 

  42. Vitolo U, Boccomini C, Ladett M, et al. High clinical and molecular response rate in elderly patients with advanced stage follicular lymphoma treated at diagnosis with a brief chemo-immunotherapy FND + rituximab [online]. Available from URL: http://http://www.hematology.org/meeting/abstracts.cfm [Accessed 2002 Dec 10]

  43. Martinelli G, Laszlo D, Mancuso P, et al. Rituximab plus chlorambucil in lowgrade non Hodgkin’s lymphomas (NHL): clinical results of a phase II study [online]. Available from URL: http://http://www.hematology.org/meetings/cfm [Accessed 2002 Dec 10]

  44. Gregory SA, Venugopal P, Adler S, et al. Combined fludarabine, mitoxantrone, and rituximab achieves a high initial response as initial treatment for advanced low grade non-Hodgkin’s lymphoma (LGNHL) [online]. Available from URL: http://http://www.hematology.org/meeting/abstracts.cfm [Accessed 2002 Dec 10]

  45. Rubio-Borja MEE, Tripp FJ, Baez E, et al. CNOP vs CNOP-R vs rituximab monotherapy as first-line therapy for indolent non-Hodgkin lymphoma (I NHL). A preliminary report from the Mexican Multicentric Hematology Study Group [online]. Available from URL: http://http://www.hematology.org/meeting/abstracts.cfm [Accessed 2002 Dec 10]

  46. Hainsworth JD, Burris HA, Yardley DA, et al. Rituximab plus short duration chemotherapy as first-line treatment for follicular non-Hodgkin’s lymphoma: a Minnie Pearl Cancer Research Network phase II trial [abstract 1070]. 38th Annual Meeting of the American Society of Clinical Oncology; 2002 May 18–21; Orlando (FL). Proc Am Soc Clin Oncol 2002; 21 (Pt 1): 268a

    Google Scholar 

  47. Rambaldi A, Lazzari M, Manzoni C, et al. Monitoring of minimal residual disease after CHOP and rituximab in previously untreated patients with follicular lymphoma. Blood 2002 Feb 1; 99(3): 856–62

    Article  PubMed  CAS  Google Scholar 

  48. Emmanouilides C, Rosen P, Telatar M, et al. Excellent tolerance of rituximab when given after mitoxantrone/cyclophosphamide: an effective and safe combination for indolent non-Hodgkin’s lymphoma. Clinical Lymphoma 2000; 1(2): 146–51

    Article  PubMed  CAS  Google Scholar 

  49. Jäeger G, Neumeister P, Brezinschek R, et al. Rituximab (anti-CD20 monoclonal antibody) as consolidation of first-line CHOP chemotherapy in patients with follicular lymphoma: a phase II study. Eur J Haematol 2002; 69: 21–6

    Article  PubMed  Google Scholar 

  50. Czuczman MS, Grillo-López AJ, White CA, et al. Treatment of patients with low-grade B-cell lymphoma with the combination of chimeric anti-CD20 monoclonal antibody and CHOP chemotherapy. J Clin Oncol 1999; 17(1): 268–76

    PubMed  CAS  Google Scholar 

  51. Czuczman MS, Fallon A, Mohr A, et al. Rituximab in combination with CHOP or fludarabine in low-grade lymphoma. Semin Oncol 2002 Feb; 29(1 Suppl. 2): 36–40

    Article  PubMed  CAS  Google Scholar 

  52. Kimby E, Geisler C, Hagberg H, et al. Rituximab (Mabthera®) as single agent and in combination with interferon-alpha-2a as treatment of untreated and first relapse follicular or other low-grade lymphomas. A randomized phase II study M 39035 [abstract 2479]. Blood 2000 Nov 16; 96 (Pt 1): 577a

    Google Scholar 

  53. Czuczman M, Grillo-López AJ, White CA, et al. Progression free survival (PFS) after six years (median) follow-up of the first clinical trial of rituximab/CHOP chemoimmunotherapy [abstract 2519]. Blood 2001 Nov 16; 98 (11 Pt 1): 601a

    Google Scholar 

  54. Gribben JG, Neuberg D, Barber M, et al. Detection of residual lymphoma cells by polymerase chain reaction in peripheral blood is significantly less predictive for relapse than detection in bone marrow. Blood 1994; 83(12): 3800–7

    PubMed  CAS  Google Scholar 

  55. Gribben JG, Neuberg D, Freedman AS, et al. Detection by polymerase chain reaction of residual cells with the bcl-2 translocation is associated with increased risk of relapse after autologous bone marrow transplantation for B-cell lymphoma. Blood 1993; 81(12): 3449–57

    PubMed  CAS  Google Scholar 

  56. Czuczman MS, Grillo-Lopez AJ, McLaughlin P, et al. Clearing of cells bearing the bcl-2 [t(14;18)] translocation from blood and marrow of patients treated with rituximab alone or in combination with CHOP chemotherapy. Ann Oncol 2001 Jan; 12: 109–14

    Article  PubMed  CAS  Google Scholar 

  57. National Cancer Institute. Adult non-Hodgkin’s lymphoma (PDQ®): treatment [online]. Available from URL: http://http://www.cancer.gov/cancerinfo/pdq/treatment/adult-non-hodgkins/healthprofessional/ [Accessed 2002 Sep 20]

  58. 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) [abstract 1142]. 38th Annual Meeting of the American Society of Clinical Oncology; 2002 May 18–21; Orlando (FL). Proc Am Soc Clin Oncol 2002; 21 (Pt 1): 286a

    Google Scholar 

  59. Ghielmini M, Schmitz S-FH, Bürki K, et al. The effect of Rituximab on patients with follicular and mantle-cell lymphoma. Ann Oncol 2000; 11: S123–6

    Article  Google Scholar 

  60. Winkler U, Schulz HR, Klein TO, et al. Treatment of patients with mantle-cell and aggressive B-cell non-Hodgkin’s lymphoma using the monoclonal anti-CD20 antibody rituximab (Rituxan™): evaluation of safety and response [abstract 4419]. Blood 1999 Nov 15; 94Suppl. 1 (10 Pt 2): 270b

    Google Scholar 

  61. 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 multicentre phase II study. Blood 1998; 92(6): 1927–32

    PubMed  CAS  Google Scholar 

  62. Foran JM, Rohatiner AZS, Cunningham D, et al. European phase II study of rituximab (chimeric anti-CD20 monoclonal antibody) for patients with newly diagnosed mantle-cell lymphoma and previously treated mantle-cell lymphoma, immunocytoma, and small B-cell lymphocytic lymphoma. J Clin Oncol 2000; 18: 317–24

    PubMed  CAS  Google Scholar 

  63. Hiddemann W, Unterhalt M, Dreyling M, et al. The addition of rituximab (R) to combination chemotherapy (CT) significantly improves the treatment of mantle cell lymphomas (MCL): results of two prospective randomized studies by the German Low Grade Lymphoma Study Group (GLSG) [online]. Available from URL: http://http://www.hematology.org/meeting/abstracts.cfm [Accessed 2002 Dec 10]

  64. Venugopal P, Gregory SA, Wooldridge J, et al. Phase II study of rituximab in combination with CHOP chemotherapy and GMCSF in patients with previously untreated aggressive non-Hodgkin’s lymphoma [online]. Available from URL: http://http://www.hematology.org/meeting/abstracts.cfm [Accessed 2002 Dec 10]

  65. Rodriguez MA, Sarris A, East K, et al. A phase II study of liposomal vincristine in CHOP with rituximab for patients with untreated aggressive B-cell non-Hodgkin’s lymphoma (NHL): a safe and effective combination [online]. Available from URL: http://http://www.hematology.org/meeting/abstracts.cfm [Accessed 2002 Dec 10]

  66. Levine AM, Espina BM, Mohrbacher A, et al. Fludarabine, mitoxantrone and Rituxan: an effective regimen for the treatment of mantle cell lymphoma [online]. Available from URL: http://http://www.hematology.org/meeting/abstracts.cfm [Accessed 2002 Dec 10]

  67. Howard OM, Gribben JG, Neuberg DS, et al. Rituximab and CHOP induction therapy for newly diagnosed mantle-cell lymphoma: molecular complete responses are not predictive of progression-free survival. J Clin Oncol 2002 Mar 1; 20: 1288–94

    Article  PubMed  CAS  Google Scholar 

  68. Vose JM, Link BK, Grossbard ML, et al. Phase II study of rituximab in combination with CHOP chemotherapy in patients with previously untreated, aggressive non-Hodgkin’s lymphoma. J Clin Oncol 2001 Jan 15; 19: 389–97

    PubMed  CAS  Google Scholar 

  69. Wilson WH, Gutierrez M, O’Connor P, et al. The role of rituximab and chemotherapy in aggressive B-cell lymphoma: a preliminary report of dose-adjusted EPOCH-R. Semin Oncol 2002; 29Suppl. 2: 41–7

    Article  PubMed  CAS  Google Scholar 

  70. Zoz M, Krämer A, Krasniqi F, et al. Taxane, cyclophosphamide plus rituximab in patients with relapsed and refractory aggressive non-Hodgkin’s lymphoma. Onkologie 2001 Sep; 24Suppl. 6: 217

    Google Scholar 

  71. Kewalramani T, Zelenetz A, Bertino J, et al. Rituximab significantly increases the complete response rate in patients with relapsed or primary refractory DLBCL receiving ICE as second-line therapy. Blood 2001 Nov 16; 98 (Pt 1): 346

    Google Scholar 

  72. Hiddemann W, Forstpointner R, Fiedler F, et al. The addition of rituximab to combination chemotherapy with fludarabine cyclophosphamide, mitoxantrone (FCM) results in a significant increase of overall response as compared to FCM alone in patients with relapsed or refractory follicular (FCL) and mantel cell lymphomas (MCL). Results of a prospective randomized comparison of the German Low Grade Study Group (GLSG) [abstract]. American Society of Hematology 43rd Annual Meeting; 2001 Dec 7–11; Orlando, 3507

  73. Younes A, McLaughlin P, Hagenmeister FB, et al. High response rate and complete remission rate achieved by adding rituximab to taxol plus topotecan (TTR) with G-CSF support for the treatment of patients with relapsed/refractory aggressive B-cell lymphoma [abstract]. American Society of Hematology 43rd Annual Meeting; 2001 Dec 7–11; Orlando, 1456

  74. Huhn D, von Schilling C, Wilhelm M, et al. Rituximab therapy of patients with B-cell chronic lymphocytic leukemia. Blood 2001 Sep 1; 98: 1326–31

    Article  PubMed  CAS  Google Scholar 

  75. Itälä M, Geisler Ch, Kimby E, et al. Standard-dose anti-CD20 antibody rituximab has efficacy in chronic lymphocytic leukaemia: results from a Nordic multicentre study. Eur J Haematol 2002; 69: 129–34

    Article  PubMed  Google Scholar 

  76. Byrd JC, Murphy T, Howard RS, et al. Rituximab using a thrice weekly dosing schedule in B-cell chronic lymphocytic leukemia and small lymphocytic lymphoma demonstrates clinical activity and acceptable toxicity. J Clin Oncol 2001 Apr 15; 19: 2153–64

    PubMed  CAS  Google Scholar 

  77. O’Brien SM, Kantarjian H, Thomas DA, et al. Rituximab dose-escalation trial in chronic lymphocytic leukemia. J Clin Oncol 2001 Apr 15; 19: 2165–70

    PubMed  Google Scholar 

  78. Byrd JC, Peterson BL, Morrison VA, et al. Randomized phase 2 study of fludarabine with concurrent versus sequential treatment with rituximab in symptomatic untreated patients with B-cell chronic lymphocytic leukemia: results from Cancer and Leukemia Group B 9712 (CALGB 9712). Blood 2003 Jan 1; 101(1): 6–14

    Article  PubMed  CAS  Google Scholar 

  79. Weiss MA, Lamanna N, Gencareli A, et al. Sequential therapy with fludarabine, high dose cyclophosphamide, and rituximab improves the quality of response in patients with previously untreated chronic lymphocytic leukemia [online]. Available from URL: http://http://www.hematology.org/meeting/abstracts.cfm [Accessed 2002 Dec 10]

  80. Keating M, Manshouri T, O’Brien S, et al. A high proportion of molecular remission can be obtained with a fludarabine, cyclophosphamide, rituximab combination (FCR) in chronic lymphocytic leukemia (CLL) [online]. Available from URL: http://http://www.hematology.org/meeting/abstracts.cfm [Accessed 2002 Dec 10]

  81. Schulz H, Klein SK, Rehwald U, et al. Phase 2 study of a combined immunochemotherapy using rituximab and fludarabine in patients with chronic lymphocytic leukemia. Blood 2002 Nov 1; 100(9): 3115–20

    Article  PubMed  CAS  Google Scholar 

  82. Polliack A, Cohen Y, Daas N, et al. Fludarabine (FLU)-containing regimen and rituximab (RI) as primary therapy with curative intent for younger patients with progressive and advanced B-CLL: high rate of initial response including molecular remissions. Blood 2001 Nov 16; 98 (Pt 1): 364

    Google Scholar 

  83. Wierda W, O’Brien S, Albitar M, et al. Combined fludarabine, cyclophosphamide, and rituximab achieves a high complete remission rate as initial treatment for chronic lymphocytic leukemia. Blood 2001 Nov 16; 98 (Pt 1): 771

    Article  Google Scholar 

  84. Garcia Manero G, O’Brien S, Cortes J, et al. Update of results of the combination of fludarabine, cyclophosphamide and rituximab for previously treated patients with chronic lymphocytic leukemia. Blood 2001 Nov 16; 98 (Pt 1): 633

    Google Scholar 

  85. Kunkel L, Wong A, Maneatis T, et al. Optimizing the use of rituximab for treatment of B-cell non-Hodgkin’s lymphoma: a benefit-risk update. Semin Oncol 2000 Dec; 27Suppl. 12: 53–61

    PubMed  CAS  Google Scholar 

  86. Conde E, Sañudo E, Garcia-Conde J, et al. Cost minimisation analysis of rituximab, CHOP and fludarabine in the treatment of relapsed or chemotherapy-refractory follicular lymphoma [abstract; in Spanish]. 4th National Congress of the FESEO; 2000 Oct 4–6; Corunna, Spain

  87. Scott SD, Hetherington N, Link BK, The cost-effectiveness of treatment of rituximab compared to fludarabine for relapsed or refractory low-grade/follicular NHL [abstract 1774]. 36th Annual Meeting of the American Society of Clinical Oncology; 2000 May 20–23; New Orleans (LA). Proc Am Soc Clin Oncol 2000; 19: 452a

    Google Scholar 

  88. Burchmore MJ, Dowden S. One year cost of treatment of rituximab compared to fludarabine for relapsed or refractory, low-grade or follicular non-Hodgkin’s lymphoma [abstract 91]. 35th Annual Meeting of the American Society of Clinical Oncology; 1999 May 15–18; Atlanta (GA). Proc Am Soc Clin Oncol 1999; 18: 25a

    Google Scholar 

  89. Coiffier B, Best JH, Omnes LF, et al. Cost-effectiveness of rituximab in treatment of diffuse large B-cell lymphoma [abstract 3586]. Blood 2001 Nov 16; 98: 864a

    Google Scholar 

  90. Omnes LF, Foutel V, Haioun C, et al. Comparative economic analysis of the treatment of relapsed low grade B-cell non-Hodgkin’s lymphoma in France using CHOP, fludarabine or rituximab [abstract 420]. Blood 1999 Nov 15; 94Suppl. 1 (10 Pt 1): 96

    Google Scholar 

  91. Sweetenham J, Hieke K, Kerrigan M, et al. Cost-minimization analysis of CHOP, fludarabine and rituximab for the treatment of relapsed indolent B-cell non-Hodgkin’s lymphoma in the U.K. Br J Haematol 1999; 106(1): 47–54

    Article  PubMed  CAS  Google Scholar 

  92. Hieke K, Sweetenham J, Omnes LF, et al. International assessment of costs of drug delivery associated with CHOP, COP, fludarabine and rituximab [abstract PP26, plus poster]. Eur J Cancer 2000 Aug; 36Suppl. 3: 17

    Google Scholar 

  93. Hamblin T, Best JH, Hornberger J, et al. Cost-effectiveness of rituximab in treatment of diffuse large B-cell lymphoma [abstract 170]. J. Haematol 2002 May; 117Suppl. 1: 59–60

    Google Scholar 

  94. Best J, Hornberger J, Omnes LF, et al. Cost-effectiveness of rituximab in diffuse large B-cell lymphoma [abstract PCN13]. Value Health 2002; 5(3): 198–9

    Article  Google Scholar 

  95. Cattaneo MJ, Nichol MB. Cost-effectiveness of rituximab in relapsed, refractory, low-grade non-Hodgkin’s lymphoma [abstract PCN7, plus poster]. Value Health 2000; 3(2): 130–1

    Article  Google Scholar 

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Acknowledgments

The full text article in Drugs 2003; 63 (8): 803-843 was reviewed by: S.M. Ansell, Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA; K. U. Chow, Department of Internal Medicine III Hematology/Oncology, Johann Wolfgang Goethe-University, Frankfurt, Germany; M. Ghielmini, Divisione di Oncologia Medica, Ospedale Civico, Istituto Oncologico della Svizzera Italiana, Lugano, Switzerland; J.D. Hainsworth, Sarah Cannon Cancer Center, Nashville, Tennessee, USA; D. Huhn, Dept of Medicine/Hematology and Oncology, Charite Campus Virchow-Klinikum, Berlin, Germany; A. Rambaldi, Divisione di Ematologia, Ospedali Riuniti, Bergamo, Italy; K. Tobinai, Hematology Division, National Cancer Center Hospital, Tokyo, Japan.

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  1. Adis International Inc., 770 Township Line Road, Suite 300, Yardley, PA, 19067, USA

    Greg L. Plosker & David P. Figgitt

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  1. Greg L. Plosker
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  2. David P. Figgitt
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Correspondence to Greg L. Plosker.

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1 This Spotlight is derived from abstract and summary text of an Adis Drug Evaluation originally published in full in Drugs 2003; 63 (8): 803–843.

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Plosker, G.L., Figgitt, D.P. Spotlight on Rituximab in Non-Hodgkin’s Lymphoma and Chronic Lymphocytic Leukemia. Am J Cancer 2, 283–289 (2003). https://doi.org/10.2165/00024669-200302040-00006

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