The spectrum of use of rituximab in chronic lymphocytic leukemia

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BlankThe spectrum of use of rituximab in chronic lymphocytic leukemia.

A Tedeschi, E Vismara, F Ricci, E Morra, and M Montillo

Onco Targets Ther, January 1, 2010; 3: 227-46.

Department of Hematology, Niguarda Ca' Granda Hospital, Milano, Italy.

The monoclonal chimeric anti-CD20 antibody, rituximab, has considerably improved

therapeutic outcome in B-cell chronic lymphocytic leukemia. Rituximab has

limited clinical activity when used as a single agent. The combination of the

monoclonal antibody with fludarabine-based regimens clearly demonstrated, in

Phase II and randomized trials, an increase in clinical efficacy in previously

untreated and pretreated patients. Furthermore the addition of rituximab enabled

the eradication of minimal residual disease, which is correlated with the

prognosis in a high proportion of patients. Although the combination of

rituximab with fludarabine-based regimens increased myelosuppression and

immunosuppression, incidence of infections did not increase. The benefit of

adding rituximab to other purine analogs or other chemotherapeutic combination

regimens has also been explored. Moreover there could be a role for achieving

better quality of responses with the combination of different monoclonal

antibodies, considering that they target different antigens and exert different

mechanism of action. Although the role of rituximab as maintenance therapy in

low grade non-Hodgkin's lymphomas has been determined, the benefit and optimal

schedule in chronic lymphocytic leukemia are still under investigation. This

review brings together knowledge of the pharmacokinetics, mechanism of action

and clinical use of rituximab in chronic lymphocytic leukemia.

PMID: 21289858