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One of the most common regimens used in the treatment of low-grade lymphoma is a chemotherapy combination of cyclophosphamide, doxorubicin, vincristine, and prednisone, often called

CHOP therapy. Now, researchers report that initial treatment with a biologic therapy, called Rituxan™, used alone, may be an effective therapy for some persons with low-grade lymphoma.

Low-grade lymphoma is a disease that is a particular kind of

non-Hodgkin’s lymphoma. Non-Hodgkin’s lymphoma is characterized by the presence of cancer cells in the lymph system, which includes the lymph nodes, lymph vessels, and organs such as the spleen, thymus, and tonsils. Non-Hodgkin’s lymphoma can start almost anywhere in the lymph system, and can then spread to other parts of the body. There are many different types and grades of non-Hodgkin’s lymphoma.

Low-grade lymphoma is considered to be a slow-growing (called

indolent) cancer. Depending on the type and stage (extent of disease at diagnosis) of cancer, treatment may include radiation therapy, chemotherapy, a trial of high-dose chemotherapy with a stem cell transplantation, and/or therapy with biologic agents, such as Rituxan.

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Rituxan is a monoclonal antibody, a type of biologic therapy (or immunotherapy) used to help the immune system fight cancer cells. This relatively new agent binds to a protein, called the CD20 antigen, that is produced by many lymphoma cells and is present specifically on the surface of mature B cells and B-cell cancerous tumors. This binding then triggers the body’s immune system to attack the mature and cancerous B cells, without causing the severe side effects associated with many other cancer treatments. Because many lymphomas express the CD20 antigen, researchers are hopeful that Rituxan may be beneficial against many lymphoma types. Studies have recently shown that the use of Rituxan, combined with CHOP therapy, may improve both response rates and survival times in persons with low-grade lymphoma. Now, researchers report that Rituxan alone may also be effective as an initial treatment for persons with low-grade lymphoma.

Researchers at the Sarah Cannon Cancer Center treated 30 persons with low-grade lymphoma with Rituxan, which was administered for 4 consecutive weeks. Patients who responded to this treatment then received repeat 4-week courses every 6 months. The results showed that 64% of patients had responses to the treatment, with 15% having complete responses, and most remaining patients having stabilization of their disease (no further growth of the cancer). The treatment was well tolerated.

These findings suggest that Rituxan is well tolerated by patients and highly active as an initial therapy for low-grade lymphoma. This may be of particular benefit in controlling this disease for a significant period of time, while avoiding the more severe side effects associated with chemotherapy. The optimal way to incorporate Rituxan into the overall treatment strategy against low-grade lymphoma, however, is still under study. Persons who have low-grade lymphoma 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 treatment strategies are being studied. Two sources of information on ongoing clinical trials that can be discussed with a doctor include a comprehensive, easy-to-use service provided by the National Cancer Institute ( and the Clinical Trials section and service offered by Cancer ( (

Blood, Vol 95, No 10, pp 3052-3056, 2000)

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