title: A pilot study of rituximab in patients with recurrent, classic Hodgkin disease.
abstract: BACKGROUND
  To explore the potential role of infiltrating benign B cells in classic Hodgkin disease (HD) lesions in supporting the survival of malignant Hodgkin and Reed-Sternberg (H/RS) cells, the authors initiated a pilot study of rituximab. Rituximab is used to primarily deplete normal B cells from HD lesions.
  
  
  METHODS
  Patients with recurrent, classic HD who had received a minimum of two prior treatment regimens, regardless of whether H/RS cells expressed CD20, were treated with 6 weekly doses of 375 mg/m2 rituximab to selectively deplete infiltrating benign B cells. Objective tumor response was determined 3 weeks after completion of the last dose of rituximab and every 3 months thereafter. Serum samples were collected from patients before they started rituximab therapy and 3 weeks after the final course of rituximab. Serum cytokine levels of interleukin 6 (IL-6), IL-10, IL-12, IL-13, and interferon gamma were determined using commercially available enzyme-linked immunosorbent assay kits.
  
  
  RESULTS
  Twenty-two patients with nodular sclerosis histology were evaluable for treatment response. Five patients (22%) achieved partial or complete remission that lasted for a median of 7.8 months (range, 3.3-14.9 months). Remissions were observed in patients only at lymph node and splenic sites, but not at extranodal sites, and were irrespective of CD20 expression by H/RS cells. Furthermore, systemic (B) symptoms resolved in six of seven patients after therapy. In two patients, partial remissions were associated with a decline in serum IL-6 levels.
  
  
  CONCLUSIONS
  The current data suggest that rituximab therapy in patients with recurrent, classic HD can alter serum IL-6 cytokine levels, can improve B symptoms, and may result in clinical remissions.
authors.affiliation: Department of Lymphoma/Myeloma, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030, USA. ayounes@mdanderson.org
authors.forename: Anas
authors.initials: A
authors.lastname: Younes
authors.forename: Jorge
authors.initials: J
authors.lastname: Romaguera
authors.forename: Frederick
authors.initials: F
authors.lastname: Hagemeister
authors.forename: Peter
authors.initials: P
authors.lastname: McLaughlin
authors.forename: Maria Alma
authors.initials: MA
authors.lastname: Rodriguez
authors.forename: Paolo
authors.initials: P
authors.lastname: Fiumara
authors.forename: Andre
authors.initials: A
authors.lastname: Goy
authors.forename: Sima
authors.initials: S
authors.lastname: Jeha
authors.forename: John T
authors.initials: JT
authors.lastname: Manning
authors.forename: Dan
authors.initials: D
authors.lastname: Jones
authors.forename: Lynne V
authors.initials: LV
authors.lastname: Abruzzo
authors.forename: L Jeffrey
authors.initials: LJ
authors.lastname: Medeiros
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20 / Q000276:immunology / Q000378:metabolism*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D005260:Female; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012008:Recurrence; D000069283:Rituximab; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D000970:Antineoplastic Agents; D000069283:Rituximab