Immunotherapy with Rituximab during Peripheral Blood Stem Cell Transplantation for Non-Hodgkin's Lymphoma

Ian W. Flinn, Paul V. O'Donnell, Amy Goodrich, Georgia Boyce Vogelsang, Ross Abrams, Steve Noga, Deborah Marcellus, Michael J Borowitz, Richard J Jones, Richard F Ambinder

Research output: Contribution to journalArticle

Abstract

Peripheral blood stem cell grafts from patients with lymphoma are often contaminated with neoplastic cells. Administration of a lymphoma-specific monoclonal antibody before collecting stem cells may be one way of reducing the contamination. Similarly, an antibody after transplantation at a time of minimal residual disease may increase the efficacy of the procedure. The objective of this study was to determine the safety of using rituximab as both an in vivo purging agent and a posttransplantation adjuvant. Eligible patients with lymphoma received 375 mg/m2 rituximab intravenously (IV) on day 1, 2.5 g/m2 cyclophosphamide IV on day 4, and 10 pg/kg per day filgrastim starting on day 5 and continuing until completion of leukapheresis. Patients subsequently received a standard preparative regimen and then received 375 mg/m2 rituximab IV 7 days after platelet independence was achieved. Twenty-five patients (14 men, 11 women; median age, 51 years) were enrolled. Of the 25 patients, 23 received transplants after at least 2.0 × 106 CD34+ cells/kg were harvested. As determined with a sensitive polymerase chain reaction assay, 6 of 7 stem cell products tested were free of tumor contamination. All patients engrafted promptly, and the rituximab infusions were well tolerated. Transient neutropenia of uncertain etiology occurred in 6 patients a median of 99.5 days posttransplantation. An additional patient developed progressive pancytopenia. Rituximab used as an in vivo purging agent and adjuvant immunotherapy with peripheral blood stem cell transplantation for non-Hodgkin's lymphoma is a well-tolerated regimen. However, the ultimate determination of efficacy will require the results of ongoing studies.

Original languageEnglish (US)
Pages (from-to)628-632
Number of pages5
JournalBiology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
Volume6
Issue number6
StatePublished - 2000

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Peripheral Blood Stem Cell Transplantation
Non-Hodgkin's Lymphoma
Immunotherapy
Lymphoma
Stem Cells
Leukapheresis
Transplants
Pancytopenia
Rituximab
Residual Neoplasm
Neutropenia
Cyclophosphamide
Blood Platelets
Transplantation
Monoclonal Antibodies
Safety
Polymerase Chain Reaction
Antibodies

Keywords

  • Immunotherapy
  • Lymphoma
  • Rituximab
  • Transplantation

ASJC Scopus subject areas

  • Transplantation

Cite this

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title = "Immunotherapy with Rituximab during Peripheral Blood Stem Cell Transplantation for Non-Hodgkin's Lymphoma",
abstract = "Peripheral blood stem cell grafts from patients with lymphoma are often contaminated with neoplastic cells. Administration of a lymphoma-specific monoclonal antibody before collecting stem cells may be one way of reducing the contamination. Similarly, an antibody after transplantation at a time of minimal residual disease may increase the efficacy of the procedure. The objective of this study was to determine the safety of using rituximab as both an in vivo purging agent and a posttransplantation adjuvant. Eligible patients with lymphoma received 375 mg/m2 rituximab intravenously (IV) on day 1, 2.5 g/m2 cyclophosphamide IV on day 4, and 10 pg/kg per day filgrastim starting on day 5 and continuing until completion of leukapheresis. Patients subsequently received a standard preparative regimen and then received 375 mg/m2 rituximab IV 7 days after platelet independence was achieved. Twenty-five patients (14 men, 11 women; median age, 51 years) were enrolled. Of the 25 patients, 23 received transplants after at least 2.0 × 106 CD34+ cells/kg were harvested. As determined with a sensitive polymerase chain reaction assay, 6 of 7 stem cell products tested were free of tumor contamination. All patients engrafted promptly, and the rituximab infusions were well tolerated. Transient neutropenia of uncertain etiology occurred in 6 patients a median of 99.5 days posttransplantation. An additional patient developed progressive pancytopenia. Rituximab used as an in vivo purging agent and adjuvant immunotherapy with peripheral blood stem cell transplantation for non-Hodgkin's lymphoma is a well-tolerated regimen. However, the ultimate determination of efficacy will require the results of ongoing studies.",
keywords = "Immunotherapy, Lymphoma, Rituximab, Transplantation",
author = "Flinn, {Ian W.} and O'Donnell, {Paul V.} and Amy Goodrich and Vogelsang, {Georgia Boyce} and Ross Abrams and Steve Noga and Deborah Marcellus and Borowitz, {Michael J} and Jones, {Richard J} and Ambinder, {Richard F}",
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AU - Flinn, Ian W.

AU - O'Donnell, Paul V.

AU - Goodrich, Amy

AU - Vogelsang, Georgia Boyce

AU - Abrams, Ross

AU - Noga, Steve

AU - Marcellus, Deborah

AU - Borowitz, Michael J

AU - Jones, Richard J

AU - Ambinder, Richard F

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N2 - Peripheral blood stem cell grafts from patients with lymphoma are often contaminated with neoplastic cells. Administration of a lymphoma-specific monoclonal antibody before collecting stem cells may be one way of reducing the contamination. Similarly, an antibody after transplantation at a time of minimal residual disease may increase the efficacy of the procedure. The objective of this study was to determine the safety of using rituximab as both an in vivo purging agent and a posttransplantation adjuvant. Eligible patients with lymphoma received 375 mg/m2 rituximab intravenously (IV) on day 1, 2.5 g/m2 cyclophosphamide IV on day 4, and 10 pg/kg per day filgrastim starting on day 5 and continuing until completion of leukapheresis. Patients subsequently received a standard preparative regimen and then received 375 mg/m2 rituximab IV 7 days after platelet independence was achieved. Twenty-five patients (14 men, 11 women; median age, 51 years) were enrolled. Of the 25 patients, 23 received transplants after at least 2.0 × 106 CD34+ cells/kg were harvested. As determined with a sensitive polymerase chain reaction assay, 6 of 7 stem cell products tested were free of tumor contamination. All patients engrafted promptly, and the rituximab infusions were well tolerated. Transient neutropenia of uncertain etiology occurred in 6 patients a median of 99.5 days posttransplantation. An additional patient developed progressive pancytopenia. Rituximab used as an in vivo purging agent and adjuvant immunotherapy with peripheral blood stem cell transplantation for non-Hodgkin's lymphoma is a well-tolerated regimen. However, the ultimate determination of efficacy will require the results of ongoing studies.

AB - Peripheral blood stem cell grafts from patients with lymphoma are often contaminated with neoplastic cells. Administration of a lymphoma-specific monoclonal antibody before collecting stem cells may be one way of reducing the contamination. Similarly, an antibody after transplantation at a time of minimal residual disease may increase the efficacy of the procedure. The objective of this study was to determine the safety of using rituximab as both an in vivo purging agent and a posttransplantation adjuvant. Eligible patients with lymphoma received 375 mg/m2 rituximab intravenously (IV) on day 1, 2.5 g/m2 cyclophosphamide IV on day 4, and 10 pg/kg per day filgrastim starting on day 5 and continuing until completion of leukapheresis. Patients subsequently received a standard preparative regimen and then received 375 mg/m2 rituximab IV 7 days after platelet independence was achieved. Twenty-five patients (14 men, 11 women; median age, 51 years) were enrolled. Of the 25 patients, 23 received transplants after at least 2.0 × 106 CD34+ cells/kg were harvested. As determined with a sensitive polymerase chain reaction assay, 6 of 7 stem cell products tested were free of tumor contamination. All patients engrafted promptly, and the rituximab infusions were well tolerated. Transient neutropenia of uncertain etiology occurred in 6 patients a median of 99.5 days posttransplantation. An additional patient developed progressive pancytopenia. Rituximab used as an in vivo purging agent and adjuvant immunotherapy with peripheral blood stem cell transplantation for non-Hodgkin's lymphoma is a well-tolerated regimen. However, the ultimate determination of efficacy will require the results of ongoing studies.

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