title: Long-Term Response and Possible Cure of Patients With B-Cell Malignancies With Dose-Escalated Rituximab.
abstract: Rituximab (R), a chimeric monoclonal antibody targeting CD20 antigen on B-cells, has become a standard of care in the treatment of B-cell malignancies, most often in conjunction with cytotoxic chemotherapy. Activity has been demonstrated in many subtypes of B-cell lymphoma, including diffuse large cell lymphoma, follicular lymphoma (FL), mantle cell lymphoma (MCL), chronic lymphocytic leukemia (CLL), lymphocyte-predominant Hodgkin lymphoma, and Waldenström macroglobulinemia (WM). Additionally, dose escalation of R as a single agent has demonstrated improved activity in previously treated/poor prognosis CLL. We present 4 cases of B-cell malignancy (2 CLL variants/MCL, 1 FL, 1 WM) who received dose-escalated R as a single agent and achieved complete response (3 patients) and stable disease/partial response (1 patient) of 6.5+ to 15+ years duration. They have been off treatment for 6.5+ to 15+ years. Toxicity was minimal, with initial infusion reactions similar to those observed with standard dose infusions. There were no serious treatment-related adverse events or infections. Dose escalated R as a single agent may possibly be curative for some patients with B-cell malignancies, unlike the standard empiric dose of 375 mg/m2, and deserves further study.
authors.affiliation: George Washington University, Washington, DC, USA.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Jacobs
authors.affiliation: Cancer Research Foundation of New York, Chappaqua, NY, USA.
authors.forename: Peter H
authors.initials: PH
authors.lastname: Wiernik
authors.affiliation: Cancer Research Foundation of New York, Chappaqua, NY, USA.
authors.forename: Janice P
authors.initials: JP
authors.lastname: Dutcher
authors.affiliation: British Hospital, Montevideo, Uruguay.
authors.forename: Pablo
authors.initials: P
authors.lastname: Muxi
keywords: B-cell malignancies; Waldenström macroglobulinemia; dose escalation; lymphoma; myeloma; rituximab