Work

Rituximab does not inhibit chemo-mobilization of HPC or engraftment following autologous transplant for lymphoma

Year: 2005

Type: article

Abstract: Treatment for patients with relapsed non-Hodgkin’s lymphoma (NHL) and Hodgkin’s lymphoma (HL) includes high-dose chemotherapy and autologous hematopoietic progenitor cell (HPC) transplant, but the role of rituximab (R) during mobilization of autologous HPC is unknown. The addition of R may purge the HPC graft of B cells but may impact negatively on mobilization or engraftment. Methods: We performed a single institution IRB-approved review of the effect R in the mobilization regimen in 80 patients with relapsed/refractory HL or NHL who underwent chemomobilization of HPC followed by autologous transplant. The study group included 32 patients with relapsed HL, 6 of who had LPHL and expressed CD20 on their lymphoma cells, and 48 patients with relapsed or refractory NHL, of whom 32 had CD20+ lymphoma. Patients received chemotherapy with or without R. Chemotherapy consisted of ICE (n= 46, 25 with R), HyperCVAD (n= 14, 8 with R), single-agent cytoxan (n= 9, 2 with R), VTEPA (n= 4, 1 plus R), CHOP (n= 3, 1 plus R), and others (n= 4, 1 with R). The conditioning regimens before transplantation were Bu/CY/VP16 for 92% of patients in the R group and 93% of those in the no R (NR) group. The content of CD34+ cells in the apheresis product was measured by flow cytometry using the ISHAGE method, and engraftment was recorded based on IBMTR criteria. Results: The average number (+ SD) of CD34+ cells collected in the entire study was 9.2× 106/kg+ 1.36 in a median of 2 days of apheresis. There were no differences in the content of CD34+ cells collected in patients who received R (9.9+ 1.5× 106 CD34+ cells/kg) versus NR (9+ 1× 106 CD34+ cells/kg), and no differences in the CD34+ cells collected from HL (10.6+ 11× 106 CD34+ cells/kg) versus NHL patients (8.6+ 13× 106 CD34+ cells/kg). Two patients in the NR arm required 2 mobilizations versus none in the R arm. Neutrophil engraftment was equal between the R and NR groups with median 13 days versus 12 days, respectively, as was platelet engraftment (median, R= 19 days vs NR= 22 days). With a medium follow-up of 1 year, there is no difference in survival in patients treated with (91%) or without R (88%). Conclusion: Rituximab during the mobilization regimen did not have adverse effects on HPC collection, neutrophil or platelet engraftment after autologous transplantation in patients with relapsed/refractory HL or NHL. The effect of including rituximab during HPC mobilization on event-free survival in autologous HPCT warrants evaluation in phase 3 trials.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2004.12.018