medigraphic.com

2020, Number 2

<< Back Next >>

Rev Hematol Mex 2020; 21 (2)

Low doses of rituximab are not effective in the treatment of children with acute lymphocytic leukemia

Colunga-Pedraza JE, Colunga-Pedraza PR, Jiménez-Antolinez YV, Gómez-González D, Morales-López ML, Sánchez-Rendón JE, González-Martínez CE, Mares-Gil JE, Estrada-Rivera EL, González-Llano Ó

Language: Spanish
References: 15
Page: 86-91
PDF size: 217.95 Kb.


ABSTRACT

Background: Rituximab is a chimeric monoclonal antibody (cAb) directed against the CD20 antigen of B lymphocytes that causes a decrease in normal and malignant lymphocytes.
Objective: To evaluate the effectiveness of incorporating reduced doses of rituximab in the treatment scheme of children with B-cell acute lymphoblastic leukemia (ALL) CD20+.
Material and Method: A pilot, experimental, non-randomized, non-blind, singlearm trial was done from September 2016 to March 2018, in which a total of 4 doses of rituximab at 100mg/m2 was incorporated into the chemotherapy treatment scheme. It was compared with a historical control group, and we evaluated the complete response (CR), global survival (GS) and events-free survival (EFS).
Results: Fourteen patients were included in the low dose scheme of rituximab and 33 patients in the historical control. CR to the treatment for minimal residual disease (MRD) was assessed, 4 patients (30%) presented MRD+ and 11 (70%) MRD- postinduction, no patient persisted with MRD+ post-consolidation. While in the historical control we found 6 patients (20%) with MRD+ and 24 (80%) MRD- post-induction, 4 patients (13%) persisted with MRD+. The rates of CR post-induction were similar in both groups; a trend was observed of better rates of CR post-consolidation in the group with low doses of rituximab with no statistically significant differences. The GS and EFS at 2 years were 61.9% and 61.9% versus 72.5% and 69.1%, respectively with no statistical significance.
Conclusion: The use of reduced doses of rituximab didn’t improve the rates of GS, EFS and CR.


REFERENCES

  1. Pui C-H, Evans WE. Treatment of acute lymphoblastic leukemia. N Engl J Med 2006;354(2):166-178. DOI: 10.1056/ NEJMra052603.

  2. Martín-Trejo JA, Núñez-Enríquez JC, Fajardo-Gutiérrez A, et al. Early mortality in children with acute lymphoblastic leukemia in a developing country: the role of malnutrition at diagnosis. A multicenter cohort MIGICCL study. Leuk Lymphoma 2017;58(4):898-908. doi: 10.1080/10428194.2016.1219904.

  3. Möricke A, Zimmermann M, Reiter A, et al. Long-term results of five consecutive trials in childhood acute lymphoblastic leukemia performed by the ALL-BFM study group from 1981 to 2000. Leukemia 2010;24(2):265-284. doi: 10.1038/leu.2009.257.

  4. Jiménez-Hernández E, Jaimes-Reyes EZ, Arellano-Galindo J, et al. Survival of Mexican children with acute lymphoblastic leukaemia under treatment with the protocol from the Dana-Farber Cancer Institute 00-01. Biomed Res Int 2015;2015:1-9. https://doi.org/10.1155/2015/576950.

  5. Aguilar-Hernández M, Fernández-Castillo G, Núñez-Villegas NN, Pérez-Casillas RX, Núñez-Enríquez JC. [Leading causes of death during the induction therapy in pediatric patients with acute lymphoblastic leukemia]. Rev Med Inst Mex Seguro Soc 2017;55(3):286-291.

  6. Dworzak MN, Schumich A, Printz D, et al. CD20 up-regulation in pediatric B-cell precursor acute lymphoblastic leukemia during induction treatment: setting the stage for anti- CD20 directed immunotherapy. Blood 2008;112(10):3982- 3988. doi: 10.1182/blood-2008-06-164129.

  7. Hunger SP, Mullighan CG. Acute lymphoblastic leukemia in children. N Engl J Med 2015;373(16):1541-1552. DOI: 10.1056/NEJMra1400972.

  8. Rao A, Kelly M, Musselman M, et al. Safety, efficacy, and immune reconstitution after rituximab therapy in pediatric patients with chronic or refractory hematologic autoimmune cytopenias. Pediatr Blood Cancer 2008;50(4):822-825. DOI: 10.1002/pbc.21264.

  9. Thomas DA, Faderl S, O’Brien S, et al. Chemoimmunotherapy with hyper-CVAD plus rituximab for the treatment of adult Burkitt and Burkitt-type lymphoma or acute lymphoblastic leukemia. Cancer 2006;106(7):1569-1580. DOI: 10.1002/cncr.21776.

  10. Tazi I, Mahmal L, Nafil H. Monoclonal antibodies in hematological malignancies: Past, present and future. J Cancer Res Ther 2011;7(4):399. doi: 10.4103/0973-1482.91999.

  11. Barth MJ, Goldman S, Smith L, et al. Rituximab pharmacokinetics in children and adolescents with de novo intermediate and advanced mature B-cell lymphoma/leukaemia: a Children’s Oncology Group report. Br J Haematol 2013;162(5):678-683. doi: 10.1111/bjh.12434.

  12. Jaime-Pérez JC, López-Razo ON, García-Arellano G, et al. Results of treating childhood acute lymphoblastic leukemia in a low-middle income country: 10 year experience in Northeast Mexico. Arch Med Res 2016;47(8):668-676. doi: 10.1016/j.arcmed.2017.01.004.

  13. Jaime-Pérez JC, Pinzón-Uresti MA, Jiménez-Castillo RA, Colunga-Pedraza JE, González-Llano Ó, Gómez-Almaguer D. Relapse of childhood acute lymphoblastic leukemia and outcomes at a reference center in Latin America: organomegaly at diagnosis is a significant clinical predictor. Hematology 2018;23(1):1-9. https://doi.org/10.1080/102 45332.2017.1333294.

  14. Gómez-Almaguer D, Tarín-Arzaga L, Moreno-Jaime B, et al. High response rate to low-dose rituximab plus high-dose dexamethasone as frontline therapy in adult patients with primary immune thrombocytopenia. Eur J Haematol 2013;90(6):494-500. doi: 10.1111/ejh.12102.

  15. Chatzidionysiou K, Lie E, Nasonov E, et al. Effectiveness of two different doses of rituximab for the treatment of rheumatoid arthritis in an international cohort: data from the CERERRA collaboration. Arthritis Res Ther 2016;18(1):50. doi: 10.1186/s13075-016-0951-z.




2020     |     www.medigraphic.com