title: Pegylated interferon plus rituximab in advanced stage, indolent lymphoma: is there CD20 antigen upregulation?
abstract: The anti-CD20 monoclonal antibody, rituximab, and interferon alpha (IFN) are active agents in advanced stage, indolent lymphoma. Some data obtained in vitro suggest upregulation of CD20 by IFN, and clinical trials have reported additive or synergistic activity of IFN with rituximab. A prospective phase II study in advanced stage, follicular and non-follicular indolent lymphoma was performed. Peginterferon alpha 2b (pegIFN) 0.5 microg/kg s.c. weekly x 6 and rituximab 375 mg/m2 i.v. weekly x 4 (beginning on week 3 of pegIFN) was administered. Quantitative CD20 antigen was measured pre-treatment and pre-rituximab in lymph node aspirates. Nine patients were treated: one complete response and three partial responses; however, all relapsed within 12 months and two were withdrawn for grade 3 toxicity (both with serum sickness). No up-regulation of CD20 was documented in seven patients studied (median change in CD20: decrease by 11.9%). PegIFN plus rituximab as delivered in this study is not recommended. PegIFN does not appear to upregulate CD20 expression in peripheral lymph node tumor cells.
authors.affiliation: Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA. portlocc@mskcc,org
authors.forename: Carol S
authors.initials: CS
authors.lastname: Portlock
authors.forename: Owen A
authors.initials: OA
authors.lastname: O'Connor
authors.forename: David J
authors.initials: DJ
authors.lastname: Straus
authors.forename: Lisa
authors.initials: L
authors.lastname: Rosenzweig
authors.forename: Otilia
authors.initials: O
authors.lastname: Dumitrescu
authors.forename: Oscar
authors.initials: O
authors.lastname: Lin
authors.forename: Peter
authors.initials: P
authors.lastname: Maslak
mesh_terms: D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20 / Q000096:biosynthesis*; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000998:Antiviral Agents / Q000008:administration & dosage; D001706:Biopsy; D005260:Female; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage*; D008198:Lymph Nodes / Q000187:drug effects* / Q000473:pathology; D008223:Lymphoma / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols; D011994:Recombinant Proteins; D000069283:Rituximab; D015854:Up-Regulation
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D000970:Antineoplastic Agents; D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D000069283:Rituximab; C417083:peginterferon alfa-2b