Rituximab: enhancing outcome of autologous stem cell transplantation in non-Hodgkin's lymphoma.

摘要

High-dose chemotherapy and autologous stem cell transplantation (ASCT) is a potentially curative therapy for younger patients with relapsed aggressive non-Hodgkin's lymphoma, and is under investigation as first-line treatment and as therapy for indolent and mantle cell non-Hodgkin's lymphoma. However, between 40% and 70% of all patients relapse after ASCT because of contamination of the stem cell product or persistence of residual tumor cells. Evidence is emerging that the administration of rituximab as an in vivo purging agent before ASCT is effective in eliminating lymphoma cell contamination, as measured by clearance of bcl-2-positive cells from stem cell harvests. Furthermore, in vivo purging with rituximab does not adversely affect the stem cell yield or function. Maintenance therapy with rituximab post-transplantation has also been explored as a means of eliminating residual tumor cells. Results suggest that rituximab may eradicate minimal residual disease post-transplant and help prevent relapse. The efficacy of both in vivo purging and maintenance therapy with rituximab is currently being investigated in a large, multicenter, randomized trial by the European Group for Blood and Bone Marrow Transplantation in patients with follicular non-Hodgkin's lymphoma. Results from this and other ongoing trials will confirm the full potential of rituximab in ASCT.