Rituximab

Rituximab (MabThera) is a recombinant chimeric IgG antibody binding to the human CD20 antigen. CD20 is expressed on pre-B cells and mature B lymphocytes, and is expressed on > 90 % of B cells in non-Hodgkin's lymphoma. CD20 expression is not detectable on haematopoietic stem cells, plasma cells, or non-haematopoietic tissues.

The effect of rituximab is mediated by induction of apoptosis in target cells, antibody-dependent cellular cytotoxicity and complement-mediated cytotoxicity.

In the treatment of CBCL rituximab has been used as a systemic infusion as well as an intralesional injection.

In an applicational observation, Gellrich et al. reported on ten patients with CBCL (FCL, MZL) (Gellrich et al. 2005). The dosage was 375 mg/m2 body surface area once per week, up to 8 weeks. All patients received premedication with hydroxyhydrochloride and indomethacin. Complete remission was observed in seven out of the ten patients, while two of the ten had a partial remission. The mean duration of remission was 23 months. Observed side effects were infusion-related fever, shivering and nausea. Laboratory analysis showed a nearly complete depletion of B cells, leaving other parameters, e.g. creatinine and alkaline phospha-tase, unchanged. During the study two patients suffered from bacterial infections; albeit no severe adverse events were recorded.

Intralesional administration of rituximab has also been shown to be effective in the treatment of CBCL (Piekarz et al. 2001). In a retrospective study, patients received 10 mg rituximab intralesionally in up to four lesions three times weekly. Cycles were repeated every 4 weeks for up to eight cycles. With this regimen a complete remission was observed in six out of seven patients. While in one patient the tumour recurred locally after 27 months, two patients had a recurrence at distant body sites after 12 and 14 months, respectively. Side effects were burning sensations at the injection site during and several hours after injections. Interestingly, B cells were depleted from the circulation, indicating systemic effects of locally applied rituximab. Intralesional injection of rituximab is especially suitable for solitary or a small number oflesions as systemic adverse events have not been observed and the amount of rituximab needed is less than for systemic administration, thus lowering treatment costs.

Currently rituximab is recommended as second line treatment for patients with relapsing or refractory CBCL and is generally well tolerated.

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