Adding fresh frozen plasma to rituximab for the treatment of patients with refractory advanced CLL

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QJM Advance Access published online on July 23, 2008

QJM, doi:10.1093/qjmed/hcn085

Adding fresh frozen plasma to rituximab for the treatment of patients with

refractory advanced CLL

A. Klepfish1, E.A. Rachmilewitz1, I. Kotsianidis2, P. Patchenko1 and A.

Schattner3

From the 1Blood Bank and Haematology Department, E. Wolfson Medical Centre,

Holon, 2The Haematology Department, Democritus University of Thrace School of

Medicine, androupolis, Greece and 3The Hebrew University Hadassah Medical

School, Jerusalem, Israel

Address correspondence to Dr Abraham Klepfish, Blood Bank and Haematology

Department, Wolfson Medical Centre, Holon. email: kelpfish@...

or to Prof. Ami Schattner, Head, Department of Medicine, Kaplan Medical Centre,

POB 1 Rehovot 76100, The Faculty of Medicine, Hebrew University Hadassah Medical

School, Jerusalem, Israel. email: amiMD@...

Received 6 May 2008 and in revised form 16 June 2008

Abstract

Background: Many patients with chronic lymphocytic leukaemia (CLL) develop

progressive, treatment-resistant disease. Rituximab (RTX), a monoclonal antibody

targeting CD20 on B lymphocytes and widely used in other indolent B cell

neoplasms is less efficacious in CLL, possibly due to associated complement

deficiencies.

Objective: To examine in open trial whether providing complement by concurrent

administration of fresh frozen plasma (FFP) will enhance the effect of RTX in

CLL.

Setting: Outpatient haematology clinics in Israel and Greece.

Patients: Five patients with severe treatment-resistant CLL. All had been

previously treated with fludarabine and three also failed treatment with RTX.

Intervention: Two units of FFP followed with RTX 375 mg/m2 as a single agent,

repeated every 1-2 weeks, as needed.

Results: A rapid and dramatic clinical and laboratory response was achieved in

all patients. Lymphocyte counts dropped markedly followed by shrinkage of lymph

nodes and spleen and improvement of the anaemia and thrombocytopenia. This could

be maintained over 8 months (median) with additional cycles if necessary.

Treatment was well tolerated in all cases.

Conclusion: Adding FFP to RTX may provide a useful therapeutic option in

patients with advanced CLL resistant to treatment.