High-Dose Rituxan® Before and After Stem Cell Transplant Improves Outcomes in Recurrent Non-Hodgkin’s Lymphoma

High-Dose Rituxan® Before and After Stem Cell Transplant Improves Outcomes in Recurrent Non-Hodgkin’s Lymphoma

According to a recent article published in the Journal of Clinical Oncology, high doses of Rituxan® (rituximab) administered before and after an autologous stem cell transplant may improve outcomes for patients with recurrent, aggressive non-Hodgkin’s lymphoma.

Lymphomas are a malignancy in which cancerous cells arise from the cells of the lymphatic system. The lymphatic system is a drainage system within the body, which consists of bone marrow, spleen, and thymus, as well as the lymph nodes and a network of small lymphatic vessels. Two of the primary functions of the lymph system are maintenance of fluid balance and production of cells called lymphocytes, which fight infection. Lymphomas can be divided into 2 types, non-Hodgkin’s lymphoma and Hodgkin’s lymphoma. Hodgkin’s lymphoma is characterized by the presence of Reed-Sternberg cells. Non-Hodgkin’s lymphoma (NHL) includes a large group of various types of cancers of the lymph and immune system. In general, NHL can be further divided into those that are slowly growing and those that progress rapidly. These subtypes of NHL may behave and respond differently to treatment, so the subtype is often the basis for the type of treatment to be used.

One type of treatment approach for NHL is an autologous stem cell transplant. This treatment involves the utilization of higher doses of therapy than normal in an attempt to kill more cancer cells than moderate-dose therapy. The use of higher doses of therapy, however, also kills more normal cells in the body, including blood cells. Low levels of blood cells can leave patients susceptible to infection, anemia, or excessive bleeding. Therefore, patients can have blood cells collected prior to therapy, which are frozen and re-infused following therapy to restore blood cells levels to normal.

Rituxan® (rituximab) is considered a biologic agent and is used extensively in the treatment of hematologic (blood) cancers. Rituxan® is a protein called a monoclonal antibody that has been designed to recognize and bind to a type of immune cell, called a B-cell, the type of cell that is commonly cancerous in NHL. The mechanisms through which Rituxan® produces anti-cancer responses are still being evaluated, but are believed to involve immune stimulation against the cells to which it is bound, as well as possible direct killing effects of the B-cells. The optimal use, sequencing, and timing of Rituxan® are still being evaluated in several clinical trials.

Researchers from the MD Anderson Cancer Center recently conducted a clinical trial to evaluate the use of Rituxan® in high doses in patients with recurrent, aggressive NHL. This trial included 67 patients who were treated with high doses of Rituxan® prior to and following an autologous stem cell transplant. Results from patients in this trial were compared to results from a group of patients with the same disease characteristics who were previously treated with the same therapeutic regimen without Rituxan® (control group). Overall survival at 2 years was 80% for patients treated with the Rituxan®, compared to 53% for the control group. Cancer-free survival was 67% at 2 years for the group of patients treated with Rituxan®, compared to 43% of patients in the control group. Infections were not significantly increased in the group of patients treated with Rituxan®.

The researchers concluded that the addition of high doses of Rituxan® prior to and following an autologous stem cell transplant may improve outcomes, including survival, in patients with recurrent, aggressive NHL. Future clinical trials directly comparing transplants with or without Rituxan® are necessary to confirm these findings. Patients with recurrent, aggressive NHL who are to undergo an autologous stem cell transplant may wish to speak with their physician about the addition of Rituxan® into their therapeutic regimen.

Reference: Khouri I, Saliba R, Hosing C, et al. Concurrent Administration of High-Dose Rituximab Before and After Autologous Stem-Cell Transplantation for Relapsed Aggressive B-Cell Non-Hodgkin’s Lymphomas. Journal of Clinical Oncology. 2005; 23: pp. 2240-2247.

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