A model of in vivo purging with Rituximab and high-dose AraC in follicular and mantle cell lymphoma.
We studied a model of in vivo purging with Rituximab and high-dose (HD) cytarabine in 14 patients with relapsed/refractory follicular lymphoma and two with refractory mantle cell lymphoma enrolled in a program of HD chemotherapy and autotransplant. After two courses of debulking immunochemotherapy with Rituximab, Vincristine and Cyclophosphamide, we used a combination of Rituximab, HD cytarabine and granulocyte colony-stimulating factor for peripheral blood stem cells (PBSC) mobilization. The median number of CD34+ cells collected was 14.69 x 10(6)/kg (range 5.74-73.2). Monitoring of peripheral CD19+ and CD20+ B cells prior to and throughout the purging period showed that a treatment with Rituximab, Vincristine and Cyclophosphamide results in a profound depletion of B cells in peripheral blood. B-cell depletion persists during mobilization with Rituximab and HD cytarabine allowing a collection of PBSC free of B cells (median CD19+ and CD20+ cells counts 0%). Of nine patients PCR positive for bcl-2 or bcl-1 in blood and marrow at the start of immunochemotherapy, all showed PCR-negative PBSC. In conclusion, in patients with indolent lymphoma, the concurrent administration of Rituximab and HD cytarabine is a safe and efficient method to obtain in vivo purged PBSC. Immunochemotherapy prior to mobilization produces B-cell depletion and seems to be a useful preparative step.
Arcaini
L
L
Division of Hematology, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy. luca.arcaini@unipv.it
Orlandi
E
E
Alessandrino
E P
EP
Iacona
I
I
Brusamolino
E
E
Bonfichi
M
M
Bernasconi
P
P
Calatroni
S
S
Tenore
A
A
Montanari
F
F
Troletti
D
D
Pascutto
C
C
Regazzi
M
M
Lazzarino
M
M
D000328:Adult; D000911:Antibodies, Monoclonal / Q000493:pharmacokinetics / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D018952:Antigens, CD34 / Q000032:analysis; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001402:B-Lymphocytes / Q000187:drug effects / Q000276:immunology; D016465:Bone Marrow Purging / Q000379:methods*; D003561:Cytarabine / Q000627:therapeutic use*; D005260:Female; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods*; D006801:Humans; D016130:Immunophenotyping; D008224:Lymphoma, Follicular / Q000188:drug therapy* / Q000628:therapy; D020522:Lymphoma, Mantle-Cell / Q000188:drug therapy* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation / Q000379:methods; D000069283:Rituximab; D016879:Salvage Therapy / Q000379:methods; D014182:Transplantation, Autologous
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018952:Antigens, CD34; D003561:Cytarabine; D000069283:Rituximab