title: Rituximab in Lymphoma and Chronic Lymphocytic Leukaemia: A Practice Guideline.
abstract: Rituximab is the first monoclonal antibody to be approved for use by the US Food and Drug Administration in cancer. Its role in the treatment of non-Hodgkin lymphoma, including chronic lymphocytic leukaemia (CLL), has evolved significantly. We aimed to systematically review and update the literature on rituximab in lymphoma and CLL, and provide evidence-based consensus guidelines for its rational use. Validated methodology from the Cancer Care Ontario Program in Evidence-based Care was used. A comprehensive literature search was completed by a methodologist from the Hematology Disease Site Group of Cancer Care Ontario. Data were extracted from randomised controlled trials of rituximab-containing chemotherapy regimens for patients with lymphoma or CLL. Fifty-six primary randomised controlled trials were retrievable and met all inclusion criteria. Clinically important benefits in progression-free survival or overall survival were seen in the following settings: (i) addition of rituximab to combination chemotherapy for initial treatment of aggressive B-cell lymphomas, including diffuse large B-cell lymphoma, Burkitt lymphoma and HIV-related lymphoma with CD4 count ≥50/mm3; (ii) addition of rituximab to combination chemotherapy for initial and subsequent treatment of follicular lymphoma and other indolent B-cell lymphomas; (iii) use of rituximab maintenance in patients with indolent B-cell lymphomas who have responded to chemoimmunotherapy; (iv) addition of rituximab to fludarabine-based chemotherapy or chlorambucil for initial treatment of CLL. The consensus opinion of the Hematology Disease Site Group is that rituximab is recommended for these indications.
authors.affiliation: Princess Margaret Hospital, Toronto, Ontario, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Prica
authors.affiliation: Program in Evidence-based Care, Cancer Care Ontario, McMaster University, Hamilton, Ontario, Canada. Electronic address: baldasf@mcmaster.ca.
authors.forename: F
authors.initials: F
authors.lastname: Baldassarre
authors.affiliation: St. Michael Hospital, Toronto, Ontario, Canada.
authors.forename: L K
authors.initials: LK
authors.lastname: Hicks
authors.affiliation: Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: K
authors.initials: K
authors.lastname: Imrie
authors.affiliation: Juravinski Cancer Centre, Hamilton, Ontario, Canada.
authors.forename: T
authors.initials: T
authors.lastname: Kouroukis
authors.affiliation: Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Cheung
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D018572:Disease-Free Survival; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy* / Q000401:mortality; D008223:Lymphoma / Q000188:drug therapy* / Q000401:mortality; D009864:Ontario; D000069283:Rituximab / Q000627:therapeutic use*
chemical_list: D000970:Antineoplastic Agents; D000069283:Rituximab
keywords: Chronic lymphocytic leukaemia; guideline; lymphoma; rituximab; systematic review