title: Rituximab plus liposomal pegylated doxorubicin in the treatment of primary cutaneous B-cell lymphomas.
abstract: BACKGROUND
  In primary cutaneous B-cell lymphomas (PCBCL), radiotherapy - or surgery in a minority of cases - is the first-line treatment in follicle center lymphoma (PCFCL) and marginal zone B-cell lymphoma (PCMZL). Conversely, patients with multifocal skin involvement or relapsed/refractory disease deserve a systemic chemotherapy. In diffuse large B-cell lymphoma, leg type (PCLBCL-LT), due its poorer outcome, cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP)-like regimens are the most commonly used frontline, although hard to propose in elderly patients. In this regard, the association of rituximab (R) and pegylated liposomal doxorubicin (PLD) can be considered a promising, alternative approach.
  
  
  OBJECTIVE
  Based on the favorable results reported with R and PLD in several recent trials, we decided to test efficacy and safety of this combination.
  
  
  METHODS
  Twelve patients with PCBCL were treated with R plus PLD, and 7 had relapsed disease. Treatment plan consisted of 2 monthly cycles of R 375 mg/m(2) and PLD 20 mg/m(2) day 1;15, followed (in responders) by two cycles given only at day 1. All patients received prophylactic pyridoxine to prevent palmar-plantar erythrodysesthesia (PPE).
  
  
  RESULTS
  Ten of 12 patients had a response (eight complete; two partial), remarkably 2/3 with PCLBCL-LT. Two patients did not respond (one progressive disease, PD, and one stable disease). Three patients died after a median follow-up of 56 months, two patients due to PD, and 1 due to a second neoplasm. Two out of 10 responders relapsed after 31 and 32 months, respectively. Hematological toxicity was negligible (one case of grade 2 neutropenia), as well as extra-hematological toxicity (two cases of grade 2 PPE).
  
  
  CONCLUSIONS
  These preliminary data suggest that R-PLD is effective and well tolerated in all subsets of PCBCL and may be offered frontline in indolent cases unsuitable for radiotherapy or surgery as well as in more aggressive cases with contraindications to CHOP-like regimens.
authors.affiliation: Division of Haematology, University Hospital of Siena, Siena, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Fabbri
authors.forename: Emanuele
authors.initials: E
authors.lastname: Cencini
authors.forename: Renato
authors.initials: R
authors.lastname: Alterini
authors.forename: Pietro
authors.initials: P
authors.lastname: Rubegni
authors.forename: Luigi
authors.initials: L
authors.lastname: Rigacci
authors.forename: Chiara
authors.initials: C
authors.lastname: Delfino
authors.forename: Benedetta
authors.initials: B
authors.lastname: Puccini
authors.forename: Michele
authors.initials: M
authors.lastname: Fimiani
authors.forename: Alberto
authors.initials: A
authors.lastname: Bosi
authors.forename: Monica
authors.initials: M
authors.lastname: Bocchia
authors.forename: Nicola
authors.initials: N
authors.lastname: Pimpinelli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D004317:Doxorubicin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016393:Lymphoma, B-Cell / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011736:Pyridoxine / Q000627:therapeutic use; D012008:Recurrence; D000069283:Rituximab; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; C506643:liposomal doxorubicin; D011092:Polyethylene Glycols; D000069283:Rituximab; D004317:Doxorubicin; D011736:Pyridoxine
keywords: liposomal pegylated doxorubicin; primary cutaneous B-cell lymphomas; rituximab; treatment