Griffin Timothy C, Weitzman Sheila, Weinstein Howard, Chang Myron, Cairo Mitchell, Hutchison Robert, Shiramizu Bruce, Wiley Joseph, Woods Deborah, Barnich Margaret, Gross Thomas G
Memorial Hospital of South Bend, South Bend, Indiana, USA.
Pediatr Blood Cancer. 2009 Feb;52(2):177-81. doi: 10.1002/pbc.21753.
To estimate the response rate and therapy related toxicities of the anti-CD20 monoclonal antibody rituximab when combined with chemotherapy including ifosfamide, carboplatin, and etoposide (ICE) in patients with relapsed and refractory B-cell non-Hodgkin lymphoma and mature B-cell acute lymphoblastic leukemia (B-ALL).
Patients received rituximab and ICE for 1-3 cycles, depending upon response. Rituximab (375 mg/m(2)) was given on day 1 and 3 of each cycle (day 1 only for cycle 3), with ifosfamide (3,000 mg/m(2)) and etoposide (100 mg/m(2)) given on days 3, 4, and 5 and carboplatin (635 mg/m(2)) given on day 3 only.
Twenty-one patients were enrolled, of whom 20 were eligible and evaluable. Although hematologic toxicities were common, only one patient was removed from study due to prolonged myelosuppression. Toxicities related to infusions of rituximab were frequent but manageable. Of the six eligible patients with diffuse large B-cell lymphoma, three achieved complete remission (CR), one had stable disease (SD), and two had progressive disease (PD). Of the 14 eligible patients with Burkitt lymphoma and B-ALL, there were four complete responses (CR), five partial responses (PR), one SD, and four with PD. Thus, the CR/PR rate for the entire group was 12/20 (60%). Following completion of protocol therapy six patients were able to proceed to consolidation with high-dose therapy and stem cell rescue.
The combination of rituximab and ICE chemotherapy was associated with an encouraging objective response (OR) rate and an acceptable toxicity profile.
评估抗CD20单克隆抗体利妥昔单抗与包含异环磷酰胺、卡铂和依托泊苷（ICE）的化疗方案联合应用于复发难治性B细胞非霍奇金淋巴瘤及成熟B细胞急性淋巴细胞白血病（B-ALL）患者时的缓解率及治疗相关毒性。
根据患者反应，给予利妥昔单抗联合ICE方案治疗1至3个周期。利妥昔单抗（375mg/m²）在每个周期的第1天和第3天给药（第3周期仅在第1天给药），异环磷酰胺（3000mg/m²）和依托泊苷（100mg/m²）在第3、4、5天给药，卡铂（635mg/m²）仅在第3天给药。
共纳入21例患者，其中20例符合条件且可评估。虽然血液学毒性常见，但仅有1例患者因长期骨髓抑制退出研究。与利妥昔单抗输注相关的毒性频繁但可控制。6例符合条件的弥漫性大B细胞淋巴瘤患者中，3例达到完全缓解（CR），1例病情稳定（SD），2例疾病进展（PD）。14例符合条件的伯基特淋巴瘤和B-ALL患者中，有4例完全缓解（CR），5例部分缓解（PR），1例SD，4例PD。因此，整个组的CR/PR率为12/20（60%）。完成方案治疗后，6例患者能够进行大剂量治疗巩固及干细胞救援。
利妥昔单抗与ICE化疗联合应用具有令人鼓舞的客观缓解（OR）率及可接受的毒性谱。
