Rituximab in chronic lymphocytic leukemia

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BlankRituximab in chronic lymphocytic leukemia.

SM Jaglowski and JC Byrd

Semin Hematol, April 1, 2010; 47(2): 156-69.

Division of Hematology-Oncology, Department of Medicine, The Ohio State

University, Columbus, OH.

Rituximab is a class I chimeric anti-CD20 antibody that has shown efficacy in

chronic lymphocytic leukemia (CLL), both as a single agent and in combination

with traditional chemotherapies. The modest activity demonstrated in early

studies evaluating rituximab in relapsed CLL was improved with higher doses or

more dose-intensive regimens that overcame the unfavorable pharmacokinetic

features commonly found in CLL. These studies led to a variety of combination

trials of rituximab with chemotherapy, where both phase II and later phase III

studies have shown great promise for the advancement of CLL therapy. Despite the

therapeutic success of rituximab in CLL, studies demonstrating the definitive

relative mechanism of tumor clearance are still lacking and this requires

further investigation. In addition to being used as a therapy for CLL, rituximab

is an effective treatment for autoimmune CLL complications such as hemolytic

anemia and immune thrombocytopenia (ITP). Patients with CLL may experience early

infusion-related side effects that can be diminished with corticosteroid

pretreatment and stepped-up dosing. Risk factors for infusion-related toxicity

may relate to atypical CLL expressing bright CD20 antigen expression, although

several different studies have not clearly implicated elevated white blood cell

count as a risk factor. Other adverse events, including delayed cytopenias,

reactivation of hepatitis B, and development of progressive multifocal

leukoencephalopathy, are rare. Future efforts focusing on novel

combination-based strategies will be required to fully appreciate the benefit of

this therapy in CLL.

PMID: 20350663

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