Rituximab for Relapsed Lymphoma after Autologous Transplant

Abstract & commentary

Synopsis: In a retrospective review of treatment of patients with aggressive lymphoma who had relapsed after stem cell transplantation, single-agent rituximab was shown to induce complete or partial responses in close to 50% of patients. This compares favorably to salvage chemotherapy as reported in prior series.

Source: Pan D, et al. Cancer J. 2002;8:371-376.

For patients with large B-cell or mantle-cell lymphoma, survival after relapse from stem cell transplantation is poor. Pan and colleagues at Memorial Sloan-Kettering Cancer Center performed a retrospective analysis to evaluate single-agent rituximab as treatment under such circumstances. Over an approximate 3-year period, 17 patients with aggressive non-Hodgkin’s lymphoma (13 with large B-cell and 4 with mantle cell) were treated with rituximab at 375/m2 weekly for 4 consecutive weeks. Transplantation had occurred a median of 10 months (range, 2-40 months) before relapse and rituximab therapy. The number of prior therapies, including the autologous stem cell transplantation, was 3 (range, 2-6).

Nine of the 17 patients responded (53%) to rituximab, with 4 complete responses and 5 partial responses. The median progression-free survival for all responders was 13 months (range, 6-18 months). Overall, the rituximab was well tolerated, with no patients developing cytopenias requiring transfusion and only 2 patients experiencing mild infusion-related symptoms.

Comment by William B. Ershler, MD

This retrospective review included patients treated from 1997 through early 2000. The findings are interesting and certainly support the impression that most oncologists already hold, which is that rituximab is active not only in follicular, well-differentiated lymphoma (for which it currently holds an FDA-approved indication), but as treatment for large-cell lymphoma as well. In fact, rituximab added to cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) was shown to be superior to CHOP alone when used as first-line therapy for elderly patients with aggressive non Hodgkin’s lymphoma (NHL).1 In patients with mantle-cell lymphoma, rituximab plus Hyper-CVAD resulted in a 2-year failure-free survival of 72%, results that may be comparable to stem cell transplantation.2 Thus, currently, few patients will reach a point of relapse from stem cell transplantation without prior experience with rituximab.

Nonetheless, the demonstration of single-agent activity of rituximab in chemotherapy-refractory, aggressive lymphoma is of importance. Future investigation might find that schedules that include rituximab following transplant may have fewer or delayed recurrence. Furthermore, there are now radiolabeled anti-CD-20 antibodies, which have yet to be of demonstrable benefit in the treatment of aggressive lymphoma,3 and it would seem likely that these agents will also be of value in aggressive lymphoma, as adjuncts to chemotherapy or in remission maintenance.

Dr. Ershler is Editor of Clinical Oncology Alert, INOVA Fairfax Hospital Cancer Center in Fairfax, VA and Director of the Institute for Advanced Studies in Aging, Washington, DC.

References

1. Coiffier B, et al. N Engl J Med. 2002;346:235-242.

2. Romaguera J, et al. Blood. [abstract]. 2001;98:1447.

3. Gordon L, et al. Proc Am Soc Clin Oncol. [abstract] 2002;266.