Researchers in Germany have reported that six cycles of Rituxan® (rituximab) and CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone), given every two weeks, should be the standard of care for elderly patients with diffuse large B-cell lymphoma. The results of this randomized trial were presented at the 47th annual meeting of the American Society of Hematology (ASH) in December of 2005.
Non-Hodgkin’s lymphoma (NHL) is a form of cancer that begins in the cells of the lymph system. The lymph system includes the spleen, thymus, tonsils, bone marrow, lymph nodes, and circulating immune cells. The main cells in the lymph system are lymphocytes, which exist in two forms: B and T-cells. Each of these cells has a specific function in fighting infection.
NHL is characterized by the excessive accumulation of atypical (cancerous) lymphocytes. These lymphocytes can crowd the lymph system and suppress the formation and function of other immune and blood cells. NHL is categorized by the type of lymphocyte it involves and by the rate at which the cancer grows-both are determined by the cells’ appearance under a microscope.
Intermediate grade non-Hodgkin’s lymphomas are the most common of all lymphomas, and are considered aggressive in nature. The most common is diffuse large B-cell lymphoma, which accounts for over 30% of all lymphomas.
Rituxan is a monoclonal antibody that has been designed to recognize and bind to B-cells. The binding of Rituxan stimulates the immune system to attack the B-cells and may also be involved in the direct killing or disabling of the B-cell.
Rituxan has become an important part of the treatment of patients with B-cell NHL. However, the optimal way to incorporate Rituxan into the overall treatment strategy for specific patients with NHL is still being intensely investigated.
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The study presented at the ASH meeting enrolled 1300 patients with diffuse large B-cell lymphoma. The median age of the study subjects was 68 years. Patients were randomly assigned to receive six or eight cycles of CHOP every two weeks with or without six to eight doses of Rituxan. At the time of the current interim analysis, information was available for 828 patients.
The researchers found that six cycles were as effective as eight cycles. They also determined that the combination of Rituxan and CHOP was more effective than CHOP alone.
The researchers conclude that Rituxan and CHOP given every two weeks should be the standard of care for elderly patients with NHL. In the U.S., standard treatment of diffuse large B-cell lymphoma often involves Rituxan and CHOP given every three weeks.
Reference: Pfreundschuh M, Kloess M, Schmits R, et al. Six, not eight cycles of bi-weekly CHOP with rituximab (R-CHOP-14) is the preferred treatment for elderly patients with diffuse large B-cell lymphoma (DLBCL): Results of the RICOVER-60 Trial of the German High-Grade Non-Hodgkin Lymphoma Study Group (DSHNHL). Blood 2005;106:9a, abstract number 13.
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