New Treatment Approaches To Indolent Non-Hodgkin’s Lymphoma☆
Section snippets
Single-agent rituximab in indolent non-hodgkin’s lymphoma
The single-agent activity of rituximab in indolent NHL was shown in the pivotal trial in patients with relapsed and refractory low-grade and follicular lymphoma.2 An overall response rate of 48% was observed, with a median response duration of 13 months. In a separate study of 31 patients with bulky disease who were excluded from the pivotal trial, a response rate of 43% was obtained, with a median time to progression of 8.1 months.3 The efficacy of rituximab in this setting is thus broadly
First-line sstudies of rrituximab monotherapy
Two studies evaluating first-line use of the standard weekly-×-4 schedule of rituximab monotherapy in patients with asymptomatic or low tumor burden stage III/IV follicular NHL have been conducted,6, 7 as well as other studies in patients with symptomatic disease in which first-line monotherapy was followed by consolidation or maintenance treatment with rituximab8, 9 or interferon-α2a.10 The efficacy of first-line rituximab in these settings is summarized in Table 1.
In a French study, 50
Combination therapy in indolent non-hodgkin’s lymphoma
Rituximab kills CD20+ cells through multiple mechanisms, including complement-mediated cytotoxicity, antibody-dependent cellular cytotoxicity, and induction of apoptosis.12, 13, 14 Rituximab has also been shown to sensitize resistant cell lines to chemotherapy in vitro.15, 16 These factors combined with minimal overlapping toxicity provide the rationale for combining rituximab with chemotherapy agents.
The efficacy and safety of rituximab in combination with CHOP (cyclophosphamide, doxorubicin,
Conclusions
Rituximab has been used in a wide range of combinations and settings in patients with indolent NHL with the goal of improving outcome compared with standard chemotherapy with encouraging results. First-line rituximab monotherapy achieves high response rates. A range of immunochemotherapy regimens have achieved response rates approaching 100%, with high complete response rates and very promising durable response durations, and the use of maintenance rituximab is being explored following
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Dr Seymour has received honoraria from Roche Pharmaceuticals and Schering AG.