Rituximab in the treatment of B-cell non-Hodgkin lymphoma, focus on outcomes and comparative effectiveness

Badin, Firas; Hayslip, John

doi:10.2147/ceor.s4221

CEOR

2010

DOI: 10.2147/ceor.s4221

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Rituximab in the treatment of B-cell non-Hodgkin lymphoma, focus on outcomes and comparative effectiveness

Firas Badin

John Hayslip

Abstract: Rituximab is an important and well established component in the treatment of many patients with B-cell non-Hodgkin lymphoma. In this paper we review recent clinical trials investigating the addition of rituximab to standard chemotherapy regimens for treatment of patients with diffuse large B cell lymphoma and follicular lymphoma. This report focuses upon treatment efficacy, quality of life, and safety of rituximab or rituximab-containing regimens. More uniquely, we review economic aspects of lymphoma treatment… Show more

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Cited by 3 publications

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Myelodysplastic syndrome and acute myeloid leukemia after receipt of granulocyte colony‐stimulating factors in older patients with non‐Hodgkin lymphoma

Calip

Moran

Sweiss

et al. 2018

Cancer

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BACKGROUND: Granulocyte colony-stimulating factors (G-CSFs), which are used for the prevention of complications from chemotherapy-related neutropenia, are linked to the risk of developing second primary myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML). The objective of this study was to examine the correlation between using a specific G-CSF agent and the risk of MDS/AML among older patients with non-Hodgkin lymphoma (NHL). METHODS: This was a retrospective cohort study of adults aged >65 years who were diagnosed with first primary NHL between 2001 and 2011. With data from the Surveillance, Epidemiology, and End Results-Medicare-linked database, adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for the risk of MDS/AML associated with the receipt of G-CSF(filgrastim and pegfilgrastim) in Cox proportional-hazards models, which were stratified according to treatment accounting for confounding by indication. RESULTS: Among 18,245 patients with NHL patients who had a median follow-up of 3.5 years, 56% received chemotherapy and/or immunotherapy, and G-CSF was most commonly used in those who received rituximab plus multiple chemotherapy regimens (77%). Subsequent MDS/AML diagnoses were identified in 666 patients (3.7%). A modest increased risk of MDS/AML was observed with the receipt of G-CSF (HR, 1.28; 95% CI, 1.01-1.62) and a trend was observed with increasing doses (P trend < .01). When specific agents were analyzed, an increased risk of MDS/AML was consistently observed with filgrastim (≥10 doses: HR, 1.67; 95% CI, 1.25-2.23), but not with pegfilgrastim (≥10 + doses: HR, 1.11; 95% CI, 0.84-1.45). CONCLUSIONS: A higher of MDS/AML was observed in patients with NHL risk among those who received G-CSF that was specific to the use of filgrastim (≥10 doses), but not pegfilgrastim. Neutropenia prophylaxis is an essential component of highly effective NHL treatment regimens. The differential risk related to the types of G-CSF agents used warrants further study given their increasing use and newly available, US Food and Drug Administration-approved, biosimilar products.

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Myelodysplastic syndrome and acute myeloid leukemia after receipt of granulocyte colony‐stimulating factors in older patients with non‐Hodgkin lymphoma

Calip

Moran

Sweiss

et al. 2018

Cancer

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Rituximab maintenance therapy for patients with diffuse large B-cell lymphoma: A meta-analysis

Zhou

Zhang

et al. 2017

PLoS ONE

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PurposeThe addition of rituximab to standard chemotherapy has significantly improved survival in patients with lymphoma. Recently, maintenance therapy with rituximab has been shown to prevent relapse and provide survival benefits for patients with follicular or mantle cell lymphoma. However, the effects of rituximab in patients with diffuse large B-cell lymphoma (DLBCL) remain unclear. Two new studies involving rituximab in the treatment of DLBCL were performed this past year. We performed a meta analysis to evaluate the effects of rituximab maintenance treatment of patients with DLBCL.MethodsSeveral databases (PubMed, MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials) databases were reviewed for relevant randomized controlled trials published prior to May, 2016. Two reviewers assessed the quality of the included studies and extracted data independently. The hazard ratios (HRs) for time-to-event data and relative risks (RRs) for the other data were pooled and estimated.ResultsTotally 5 studies including 1740 patients were eligible for the meta-analysis. Compared to the observation group, patients who received rituximab maintenance therapy had significantly improved event-free survival (EFS) (HR = 0.80, 95% CI: 0.65–0.98) and progression-free survival (PFS) (HR = 0.72, 95% CI: 0.54–0.94). However, there was no statistically significant difference in overall survival (OS) (HR = 0.66, 95% CI: 0.27–1.29). A subgroup analysis suggested that male patients may benefit from rituximab maintenance therapy with a better EFS (HR = 0.53, 95% CI: 0.34–0.82-), while this advantage was not observed in female patients (HR = 0.99, 95% CI: 0.64–1.52).ConclusionsRituximab maintenance may provide survival benefits beyond that afforded by first- and second-line chemotherapy alone, especially in male patients. However, maintenance rituximab treatment may cause more adverse events. It is recommended that both survival benefits and adverse events should be taken into consideration when making treatment decisions.

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Experience of the safety evaluation of the cellular immunotherapy application on basis LAC for canine oncological diseases treatment

Фатеева¹,

Корнюшенков²,

Kornyushenkov

et al. 2019

Russian Veterinary Journal

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Purpose of research. To evaluate the effect of LAC (mononuclear blood leukocytes activated by IL-2 ex vivo) suspension infusion on clinical, biochemical, hematological and immunological characteristics of a healthy Beagle dog to assess the safety of the product’s application. Materials and methods. The research object is a 6-year Beagle dog male. The LAC suspension in Hank’s solution has been infused intravenously with a low rate of administration; the dose used was 25 m cells in 5 ml. An autologous culture of LAC has been generated from canine blood, evaluated by morphology, phenotype, and target activity in Laboratory of Cell Immunity by FBSI «N.N. Blokhin National Medical Research Center of Oncology». Results. The analysis of hematological, immunological and radiological characteristics of the object has identified no signs of any pathology development. That turns to conclusion that the given LAC medication dose’s local, hematological and systemic toxicity is low or absent. Conclusions. Data received within the research may be of interest to human medicine as well as to veterinary medicine as it could be considered a part of pre-clinical trials of the LAC suspension, which effectiveness has already been confirmed in human clinical oncology, and also as a safety assessment of even more complex constructs based on activated immunocompetent cells that are still under development. The study can serve as a basis for the development of activated leukocytes-based cellular anticancer immunotherapy (LAC, immune checkpoint molecules and SAR), primarily its toxicity studying models, and also be a part of pre-clinical studies of LAC toxicity.

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Rituximab in the treatment of B-cell non-Hodgkin lymphoma, focus on outcomes and comparative effectiveness

Cited by 3 publications

References 50 publications

Myelodysplastic syndrome and acute myeloid leukemia after receipt of granulocyte colony‐stimulating factors in older patients with non‐Hodgkin lymphoma

Myelodysplastic syndrome and acute myeloid leukemia after receipt of granulocyte colony‐stimulating factors in older patients with non‐Hodgkin lymphoma

Rituximab maintenance therapy for patients with diffuse large B-cell lymphoma: A meta-analysis

Experience of the safety evaluation of the cellular immunotherapy application on basis LAC for canine oncological diseases treatment

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