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According to a recent article published in the Journal of Clinical Oncology, the addition of Rituxan® (rituxamab) to the chemotherapy and interferon combination known as CHVP-I may improve prognosis for patients diagnosed with follicular lymphoma who have a high number of cells known as tumor macrophage cells.

Non-Hodgkin’s Lymphoma (NHL) is a malignancy in which cancerous cells arise from cells of the lymphatic system, which includes the spleen, thymus, tonsils, bone marrow, lymph nodes, and circulating immune cells. The lymphatic system is a drainage system within the body. Two of its primary functions are to maintain fluid balance and produce cells called lymphocytes, which fight infection.

Lymphocytes are the main cells of the lymph system and are classified into two forms: B- and T-cells. Each of these cells has specific functions to help the body fight infection. B-cells, which are white blood cells, are the cells most commonly affected by NHL. A specific type of lymphoma that affects B-cells is known as follicular lymphoma. When NHL is diagnosed, various tests are performed to determine the types of cells affected, as well as the extent to which the disease has spread. These tests may include blood tests, X-rays, CT Scans, and biopsies.

Macrophages are one type of cell that may be evaluated. Macrophages are white blood cells that are responsible for attacking and digesting cellular debris as well as any foreign invaders or pathogens that may cause infection. Once destroyed macrophages stimulate white blood cells to continue fighting infection. The presence of large numbers of macrophages among patients diagnosed with follicular lymphoma has been associated with poor outcomes when treated with chemotherapy alone.

In this recent study, researchers sought to determine if the addition of Rituxan could improve the prognosis of patients diagnosed with follicular lymphoma who also had a high number of tumor macrophage cells.

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Researchers analyzed blood samples of 194 patients diagnosed with follicular lymphoma. These patients were enrolled in another study where they were treated with either a combination of chemotherapy and interferon (CHVP-I [cyclophosphamide, doxorubicin, etoposide, prednisolone, and interferon]) or CHVP-I plus Rituxan. Their blood samples allowed researchers to determine the number of tumor-associated macrophages.

  • Among patients treated with CHVP-I, those with lower numbers of macrophages had improved outcomes compared with those with higher numbers of macrophages.
  • Among patients treated with the addition of Rituxan to CHVP-I, outcomes were similar between those with low or high numbers of macrophages.
  • The study also found, however, that patients with higher levels of macrophages who were treated with CHVP-I plus Rituxan had more favorable outcomes than patients treated with CHVP-I alone.

Researchers concluded that levels of macrophages are associated with outcomes among patients diagnosed with follicular lymphoma. Specifically, higher levels of macrophages are associated with poorer outcomes, while lower levels are associated with improved outcomes when patients are treated with CHVP-I. The addition of Rituxan, however, among patients with high levels of macrophages significantly improves their outcomes.

Reference: Canioni, D., Salles, G., Mournier, N., et al. High numbers of tumor-associated macrophages have an adverse prognostic value that can be circumvented by rituximab in patients with follicular lymphoma enrolled onto the GELA-GOELAMS FL-2000 trial. Journal of Clinical Oncology. 2008. Vol. 26: 440-446.

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