Терапевтический архив (Jan 2003)
Mabtera (rituximab) treatment of patients with refractory' course of B-cell lymphoma on high-dose chemotherapy with autologous transplantation of hemopoiesis precursor cells
Abstract
Aim. To study efficacy of htuximab in patients with resistant B-cell lymphoma on high-dose chemotherapy. Material and methods. From September 2000 to April 2002 we studied efficacy and tolerance of rituximab at different stages of high-dose chemotherapy. The treatment was given to 10 patients with histologically verified CD20+ non-Hodgkln's lymphoma: diffuse large-cell (n = 4), Berkitfs (n = 2), follicular (n - 3), mantle-cell (n = 1). Five patients with diffuse large-cell lymphoma and Berkitt's lymphoma had a primary resistant course of the disease, one patient with diffuse large-cell lymphoma had a refractory recurrence. Follicular and mantle-cell lymphomas were characterized by a resistant course and large tumar masses. The patients received 1-2 courses of induction chemotherapy with dexa-BEAM with collection of peripheral stem cells followed by high-dose chemotherapy (BEAM-9, CBV+mitoxantron-1) with transplantation of autologous stem blood cells. Rituximab infusion (375 mg/m2) was conducted before the collection of the stem cells, prior to high-dose chemotherapy and in posttransplantation period after recovery of hemopoiesis. Results. 4 patients achieved complete remission, 3 - partial remission, 2 had progression and 1 - stabilization. In mean follow-up 11 (2-20) months 7 of 10 patients were alive, overall survival being 15 + 2.4 months (95% confidence interval 10-19.7), median was not reached. 5patients are in complete remission: 2 of them without further treatment, 3 - after progression and repeat therapy including rituximab and interferon-a or rotuximab and CHOP chemotherapy. Conclusion. The addition of rituximab can improve the results of high-dose chemotherapy of patients with non-Hodgkin's lymphoma resistant to standard doses of cytostatics. Repeat use of this drug can be effective in some patients with progression after high-dose chemotherapy with rituximab.
