Kaya Hakan, Keung Yi-Kong, Case Douglas, Cruz Julia M, Perry James J, Radford James E, Hurd David D
Comprehensive Cancer Center of Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.
Biol Blood Marrow Transplant. 2002;8(10):544-9. doi: 10.1053/bbmt.2002.v8.pm12434949.
The major cause of treatment failure following high-dose therapy with autologous hematopoietic cell transplantation (AHCT) for low-grade lymphomas (non-Hodgkin's lymphoma [NHL]) is persistent disease or recurrence. Most patients whose disease progresses following AHCT have resistant disease and limited bone marrow reserve. In this setting, treatment options are limited and responses to conventional chemotherapy are generally poor. Rituximab is a chimeric immunoglobulin G1 kappa monoclonal antibody that recognizes the CD20 antigen on B-cells. Published data on the use of rituximab for the treatment of recurrent NHL after autologous transplantation are limited. We present a detailed report of anti-CD20 antibody treatment for 8 patients with recurrent follicular low-grade NHL after high-dose therapy and autologous transplantation. Rituximab was administered at 375 mg/m2 intravenously once weekly for a total of 4 infusions. Median follow-up for this study was 23.4 months. Six (75%) of 8 patients responded to rituximab (2 complete response, 4 partial response). The Kaplan-Meier estimated median time to progression was 17.8 months. Rituximab was generally well tolerated. One patient developed delayed neutropenia. Other side effects were infusion related and transient. Two patients were re-treated with rituximab for progressive disease and achieved partial response. In summary, this retrospective study suggests that anti-CD20 antibody treatment is feasible in the treatment of patients who relapse or progress with low-grade NHL after autologous transplantation. There appears to be a high proportion of patients who benefit and have durable responses. Anti-CD20 antibody should be considered as a first-line salvage treatment for patients with CD20+ recurrent low-grade NBL in whom high-dose therapy has failed.
对于低度淋巴瘤（非霍奇金淋巴瘤[NHL]），采用大剂量自体造血细胞移植（AHCT）治疗后出现治疗失败的主要原因是疾病持续存在或复发。大多数在AHCT后疾病进展的患者存在耐药性疾病且骨髓储备有限。在这种情况下，治疗选择有限，对传统化疗的反应通常较差。利妥昔单抗是一种嵌合免疫球蛋白G1κ单克隆抗体，可识别B细胞上的CD20抗原。关于利妥昔单抗用于自体移植后复发性NHL治疗的已发表数据有限。我们提供了一份详细报告，内容是对8例大剂量治疗和自体移植后复发性滤泡性低度NHL患者进行抗CD20抗体治疗的情况。利妥昔单抗以375mg/m²静脉注射，每周一次，共输注4次。本研究的中位随访时间为23.4个月。8例患者中有6例（75%）对利妥昔单抗有反应（2例完全缓解，4例部分缓解）。采用Kaplan-Meier法估计的中位疾病进展时间为17.8个月。利妥昔单抗总体耐受性良好。1例患者出现延迟性中性粒细胞减少。其他副作用与输注相关且为一过性。2例患者因疾病进展接受利妥昔单抗再次治疗并获得部分缓解。总之，这项回顾性研究表明，抗CD20抗体治疗对于自体移植后低度NHL复发或进展的患者是可行的。似乎有很大比例的患者从中受益且反应持久。对于大剂量治疗失败的CD20+复发性低度NBL患者，应将抗CD20抗体视为一线挽救治疗方法。
