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Rituximab Standard Therapy Effective for Many Non-Hodgkin's Lymphomas: Presented at ASH

By Charlene Laino

SAN DIEGO, CA -- December 6, 2004 -- The monoclonal antibody rituximab has rapidly been incorporated into upfront treatment regimens for a variety of nonHodgkin's lymphomas, regardless of histology, according to a new analysis from the National Comprehensive Cancer Network (NCCN).

"At major medical centers throughout the United States, rituximab is being used for all kinds of nonHodgkin's lymphomas, even when there's no [Food and Drug Administration] indication," said Eva M. Lepisto, MSc, MS, director, Outcomes Database Operations, National Comprehensive Cancer Network, Jenkintown, Pennsylvania. Noting the high cost of biologic agents, she said, "It must be because they are getting good results."

Reporting here on December 4th at the American Society of Hematology 46th Annual Meeting, Ms. Lepisto said that inclusion of rituximab as standard therapy for follicular and diffuse large B-cell lymphomas predated NCCN guidelines inclusion, while use in mantle cell and other nonHodgkin's lymphomas predated Food and Drug Administration approval for those indications.

In the United States, rituximab was approved in November 1997 for treatment of patients with relapsed or refractory, low-grade or follicular, CD20-positive, B-cell nonHodgkin's lymphoma. While recent clinical trials indicate that it improves response rates in mantle cell and other lymphomas as well, rituximab has yet to be approved for these indications.

For the study, the researchers used the NCCN outcomes database to analyze rituximab use in 575 patients with newly diagnosed nonHodgkin's lymphoma between July 2000 and July 2003. Forty-five percent had diffuse large B-cell lymphoma, 29% had follicular lymphoma, 11% had mantle cell lymphoma, and 11% had other histologies, including small lymphocytic, splenic marginal zone, and nodal marginal zone nonHodgkin's lymphomas.

Rituximab was given as part of the initial treatment regimen to 87% of DCLC patients, 86% of mantle cell patients, 52% of follicular cell patients, and 51% of "other" patients.

In the case of follicular cancer, rituximab use varied widely in the 5 centers studied, Ms. Lepisto said, ranging from less than 10% to over 80%. Nevertheless, adaptation of standard rituximab utilization in most institutions predated NCCN guideline inclusion, and occurred while national trials evaluating its benefit were still accruing, she said.


[Presentation title: Evolution of Rituximab as "Standard" Therapy in Patients (pts) With Newly Diagnosed Follicular (FL), Mantle Cell (MCL), and Diffuse Large B Cell (DLCL) Non-Hodgkin's Lymphoma (NHL) in 5 United States Comprehensive Cancer Centers: An Analysis from the National Comprehensive Cancer Network (NCCN) NHL Outcomes Project. Poster1391]

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