Zdravljenje Nehodgkinovih limfomov z rituksimabom

The introduction of rituximab into the treatment of patients with Non-Hodgkin's lymphomas has changed the long term prognosis of patients with CD20 positive B-cell lymphomas, especially follicular and diffuse large B-cell lymphomas. The NCCN guidelines recommend the application of rituximab also for the treatment of patients with other types of lymphomas, such as marginal cell lymphomas, mantle cell lymphomas and chronic lymphocytic leukemia. The addition of rituximab to chemotherapy improves the overall response rate, prolongs the response duration and the overall survival both in the patients with follicular and other indolent CD20 positive lymphomas and diffuse large B-cell lymphomas. Maintenance treatment with rituximab in the patients with indolent lymphomas further prolongs the remission and some of the studies have also shown the survival benefit. However, the maintenance therapy in aggressive lymphomas most probably gives no further improvement in the patients who received rituximab already in the induction treatment. Rituximab has been used at the Institute of Oncology Ljubljana since 1998. In the period from 2004 to 2006, we have treated 340 patients with rituximab either as a single agent (minority of patients) or in combination with chemotherapy. Our treatment group included 46.8% of patients with diffuse large B-cell lymphomas and 19.4% with follicular lymphomas; 67.4% of patients were treated with R-CHOP combination, while the others received different rituximabchemotherapy combinations. The overall response rate regardless of the histological type of lymphoma was 78.8% (62.4% complete responses, 2.6% unconfirmed complete responses, 13.8% partial responses) and the highest response rate was achieved in the patients with aggressive follicular lymphomas (91.7%). In 75% of patients, regardless of the histological type of lymphoma, the response lasted more than 12 months, the median response duration has not been reached yet. The longest disease-free survival was observed in the patients with diffuse large B-cell lymphomas. The overall survival rate of all patients, regardless of the type of lymphoma, was 75% 26 months after the beginning of treatment and the median overall survival has not been reached yet. The longest overall survival was observed in the patients with indolent follicular lymphomas. The treatment results with rituximab obtained at the Institute of Oncology Ljubljana are comparable to the results of larger randomized trials. According to the beneficial influence of rituximab on the long term prognosis of patients with CD20 positive lymphomas, it became the standard of treatment in these patients.