Immunotherapeutic and immunoregulatory drugs in haematologic malignancies.
A better understanding of the biology and pathogenesis of hematological malignancies has led to the development of immunotherapeutic and immunoregulatory drugs. Many of these agents have revolutionized the current treatment modalities, while others are under investigation. Rituximab (anti-CD20 antibody) has been established as the gold standard of treatment for aggressive B-cell lymphomas in combination with CHOP and has shown significant activity as monotherapy in the treatment of indolent B-cell lymphomas. In follicular lymphomas the combination of Rituximab with chemotherapy improves the outcome compared to chemotherapy alone. CD 20-based radioimmunotherapy, with the advantage of the bystander effect, represents an additional therapeutic alternative in B-cell lymphomas and may produce tumor regression in Rituximab resistant patients. The anti-CD52 monoclonal antibody, alemtuzumab, further expands the armamentarium against lymphoid malignancies producing high response rates in these entities. Antibody-targeted chemotherapy such as gemtuzumab ozogamicin, consisting of an anti-CD33 antibody combined to calicheamicin, has shown efficacy in the treatment of refractory acute myeloid leukemia; exact indications, timing and dosing schedule for optimized efficacy remain to be determined. Interferons have proven significant activity in cutaneous lymphomas, hairy cell leukemia and chronic myelogenous leukemia by mechanisms that are not fully elucidated. Thalidomide, by acting as an immunomodulatory and antiangiogenic agent can modulate neoplastic cells microenvironment and lead to disease control in multiple myeloma as well as in numerous other hematological malignancies. Bortezomib, a proteasome inhibitor, displays significant anti-tumor activity, especially in multiple myeloma and lymphoproliferative disorders. The addition of these agents in therapeutic regimens has improved considerably the treatment of hematological malignancies.
Pangalis
Gerassimos A
GA
First Department of Internal Medicine, First Department of Propedeutic Internal Medicine & Department of Hematology, National and Kapodistrian University of Athens Medical School, Laikon General Hospital, Athens, Greece. pangalis@otenet.gr
Kyrtsonis
Marie-Christine
MC
Vassilakopoulos
Theodoros P
TP
Dimopoulou
Maria N
MN
Siakantaris
Marina P
MP
Emmanouilides
Christos
C
Doufexis
Dimitris
D
Sahanas
Sotirios
S
Kontopidou
Flora N
FN
Kalpadakis
Christina
C
Angelopoulou
Maria K
MK
Dimitriadou
Evangelia M
EM
Kokoris
Styliani I
SI
Panayiotidis
Panayiotis
P
D000818:Animals; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D019337:Hematologic Neoplasms / Q000188:drug therapy* / Q000276:immunology / Q000628:therapy*; D006801:Humans; D007116:Immunization, Passive / Q000379:methods* / Q000639:trends
D000970:Antineoplastic Agents