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Rituxan™ is a biologic therapy approved by the U.S. Food and Drug Administration (FDA) for the treatment of follicular or low-grade B-cell non-Hodgkin’s lymphoma for which the standard first-line therapies are not or are no longer working. Now, study results show that this agent may also be effective as an initial therapy against previously untreated follicular or low-grade lymphoma, according to a report presented by California researchers at the American Society of Clinical Oncology meeting, held May 2000 in New Orleans.

Lymphomas that are referred to as

low-grade lymphomas or

follicular lymphomas are types of non-Hodgkin’s lymphoma.

Non-Hodgkin’s lymphoma (NHL) is a cancer of the lymph tissue, which is present in the lymph nodes, lymph vessels, bone marrow, and organs such as the thymus, tonsils, and spleen. One of the main cells in the lymph system is the

lymphocyte, of which there are 2 types: B and T cells. The large majority of NHL cases involves cancer of the

B lymphocytes, characterized by the rapid, excessive multiplication of these cells (sometimes referred to as

B-cell NHL or B-cell lymphoma). While NHL is categorized by the type of lymphocyte it involves, it is also further defined by the specific appearance of the affected cells as well as the grade (how fast it is likely to grow) of the disease, based on how the cells look under a microscope. In terms of NHL grade,

low-grade NHL is the slowest growing,

intermediate-grade NHL is fast growing, and

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high-grade NHL is the fasted growing. The term

follicular lymphoma refers to NHL in which the cancer cells appear clustered together, rather than being further apart, under the microscope. Follicular NHL may be either low or intermediate in grade.

The treatment options for low-grade follicular or other low-grade NHL depend on the specific type and stage (extent of disease at diagnosis) of disease, but may include: no therapy until symptoms appear, radiation therapy alone, chemotherapy alone, or a combination of chemotherapy and radiation therapy. Treatments using new chemotherapy drugs; high doses of chemotherapy/radiation therapy with a stem cell transplantation; and different types of biologic therapies are being studied in clinical trials.

One relatively new biologic therapy that continues to show promise is

Rituxan. This agent is a monoclonal antibody, a type of biologic therapy (or immunotherapy) used to help the immune system fight cancer cells. Rituxan binds to a protein, called the CD20 antigen, that is present on the surface of B cells (B lymphocytes). This binding then triggers the body’s immune system to attack the B cells. Since most NHL cases involve cancer of the B-cell lymphocytes, this treatment strategy allows more cancer cells to be targeted, while minimizing the effects on normal cells and avoiding many of the severe side effects associated with chemotherapy. The FDA recently approved Rituxan to treat persons with follicular or low-grade B-cell NHL for which the standard first-line therapies are not or are no longer working. Researchers hold hope that Rituxan will also be useful as a first-line therapy for newly diagnosed follicular or low-grade NHL, providing an additional treatment option for persons with this type of disease.

Researchers in San Diego treated 20 adults who had previously untreated follicular or low-grade NHL. All patients received 4 weekly infusions with Rituxan. Overall, 50% of patients had a response to the treatment. Three patients received an additional course of Rituxan when their disease began to progress again; 2 of these persons are currently receiving monthly infusions of Rituxan to maintain the treatment response. The overall duration of responses in these patients is yet to be determined. The treatment was well tolerated, with fever, chills, and itching being the most frequently occurring side effects.

The researchers concluded that Rituxan administered as a first-line therapy appears to produce response rates and side effects similar to those achieved with Rituxan administered as a second-line therapy (given after chemotherapy). Further study, comparing Rituxan directly with other commonly used therapies, is needed to determine the full role of Rituxan in the treatment of follicular or low-grade NHL. Persons who have this type of disease may wish to talk with their doctor about the risks and benefits of participating in a clinical trial in which Rituxan as an initial treatment or other promising new therapies are being studied. Two sources of information on ongoing clinical trials include clinical trials listing services provided by the National Cancer Institute ( and also performs personalized clinical trial searches on behalf of patients. (

Proceedings of the American Society of Clinical Oncology Thirty-Sixth Annual Meeting, Vol 19, Abstract 79, p 22a, 2000)

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