Rituximab May Buy Time for NHL Patients Who Progress After Stem Cell Transplant

PHILADELPHIA—Patients with intermediate-grade non-Hodgkin’s lymphoma (NHL) whose disease progresses after high-dose chemotherapy and stem cell transplant have few options among conventional regimens. However, Donald E. Tsai, MD, PhD, reported at the ASH meeting that the anti-CD20 monoclonal antibody rituximab (Rituxan) is active in this situation.

Dr. Tsai and his colleagues at the University of Pennsylvania treated seven such patients with rituximab, two of whom were re-treated. There were two complete responses, four partial responses, and one mixed response. Median duration of response was 170 days; performance status improved to 0 in five patients.

“There is no good treatment for this patient population. Most relapse quickly after transplant. Some are still so ill from the transplant that they are not eligible for anything else. All those we treated with rituximab responded, and several then became eligible for other treatments,” Dr. Tsai said in an interview. “We hope that rituximab may buy these patients time to become eligible for other therapies.”

Dr. Tsai gave rituximab (375 mg/m² per week IV for 4 weeks) to seven patients with CD20-positive, diffuse large-cell non-Hodgkin’s lymphoma. All had progressive disease despite high-dose therapy with peripheral blood stem cell transplant.

Of the five patients who were initially symptomatic from NHL, two had complete resolution and three had improvement in their symptoms by completion of the 4-week rituximab course.

At initial restaging (days 23 to 79) and after initiation of therapy, six of seven patients responded (one CR and five PR) and one patient had stable disease (SD).

Two patients (one SD and one PR) later developed progressive disease at day +60 and day +87, respectively, and underwent re-treatment with rituximab. One patient achieved CR and the other had a mixed response.

Progression-Free Time

“With a median follow-up of 170 days from initiation of therapy, and with two patients having undergone re-treatment, there currently are two CRs, four PRs, and one PD,” Dr. Tsai said.

The median progression-free time after rituximab treatment of 170 days “gives patients time to recover, get back on their feet, let their hair grow back in. Then you can think about trying something else,” he said.

Acute complications of rituximab consisted of rash and rigors in one patient during the first infusion only. Delayed adverse events included three episodes of transient granulocytopenia, occurring from day 74 to day 112 and resulting in one hospitalization for neutropenic fever.

“Two of these patients were very responsive to G-CSF and bounced back. The other recovered without treatment,” Dr. Tsai said.

The incidence of granulocytopenia was higher than that seen with rituximab in low-grade NHL but was transient and lower than with conventional salvage chemotherapy.