Critical appraisal of rituximab in the maintenance treatment of advanced follicular lymphoma

Aguiar-Bujanda, David; Blanco, María Jesús; Hernández-Sosa, María; Galván-Ruíz, Saray; Hernández-Sarmiento, Samuel

doi:10.2147/cmar.s69145

Cited by 3 publications

(4 citation statements)

References 87 publications

(120 reference statements)

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“…Rituximab is a chimeric monoclonal antibody that responds specifically to the CD20 antigens found on the surface of malignant and normal B-cells. [22,23] The majority of responders responded to rituximab within 4 weeks, whereas the rest responded more slowly, several weeks, or even months after rituximab treatment. [24] Toxicity was manageable.…”

Section: Discussionmentioning

confidence: 99%

Risk factor analysis of autoimmune hemolytic anemia after allogeneic hematopoietic stem cell transplantation in children

et al. 2016

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Autoimmune hemolytic anemia (AIHA) is a clinically relevant complication after allogeneic hematopoietic stem cell transplantation (HSCT). Currently, there is no established consensus regarding the optimal therapeutic approach. Whether AIHA contributes to increased mortality is still somewhat controversial.We investigated the incidence, risk factors, and outcome of post-transplant AIHA in 265 consecutive pediatric patients undergoing allo-HSCT over a 17-year period. Onset of AIHA was calculated from the first documented detection of AIHA by either clinical symptoms or positive direct agglutinin test. Resolution of AIHA was defined as normalization of hemoglobin and biochemical markers of hemolysis with sustained transfusion independence.We identified 15 cases of AIHA after allo-HSCT (incidence rate, 6%). Ten (67%) of these patients had a positive direct antiglobulin test. Data were obtained for 9 boys and 6 girls after a median follow-up of 53 months (range 4–102). The median age was 5.1 years (range 0.5–15.4) at the time of HSCT and the median time to emergence was 149 days (range 42–273). No significant risk factor for post-transplant AIHA has emerged from our data to date. In the majority (14 of 15; 93%) of AIHA patients, multiple agents for treatment were required, with 12 of 15 (80%) patients achieving complete resolution of AIHA. No splenectomy was performed in any of our patients.For various reasons, post-transplantation AIHA poses an extraordinary challenge to transplant physicians. Despite the advancements in diagnostic tools, therapeutic challenges remain due to the myriad interacting pathways in AIHA.

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Section: Discussionmentioning

confidence: 99%

Risk factor analysis of autoimmune hemolytic anemia after allogeneic hematopoietic stem cell transplantation in children

et al. 2016

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“…Whereas FL grades 1, 2, and 3A are indolent, grade 3B is generally considered as an aggressive lymphoma and treated with curative intent according to the recommendations for diffuse large B‐cell lymphoma . Approximately 89% of patients with indolent FL are diagnosed in Ann‐Arbor stages III or IV, which are not curable with conventional therapy …”

Section: Introductionmentioning

confidence: 99%

“…4,5 Approximately 89% of patients with indolent FL are diagnosed in Ann-Arbor stages III or IV, which are not curable with conventional therapy. 6 The advent of the anti-CD20 antibody rituximab significantly improved the treatment options for FL. For remission induction, rituximab is most frequently combined with chemotherapy, such as CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone), 7 bendamustine, 8 or CVP (cyclophosphamide, vincristine, prednisone).…”

Section: Introductionmentioning

confidence: 99%

Rituximab maintenance therapy of follicular lymphoma in clinical practice

Broszeit-Luft¹,

Dieing

Lück

et al. 2018

Cancer Medicine

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Standard of care for patients with symptomatic, advanced‐stage follicular lymphoma (FL) is rituximab‐containing chemoimmunotherapy followed by rituximab maintenance. This prospective, multicenter, noninterventional study analyzed how efficacy and safety data from randomized controlled trials translate into clinical practice in Germany. Both treatment‐naïve and relapsed/refractory patients with FL, who responded to rituximab‐containing induction and were scheduled for rituximab maintenance, were observed for 24 months. Effectiveness was measured by response and Kaplan‐Meier survival analysis. In addition, treatment patterns of induction and maintenance, as well as adverse events, were documented. The evaluable study population consisted of 310 first‐line patients and 173 relapsed/refractory patients, including 116 patients with initial Ann‐Arbor stage I/II and 20 patients with FL grade 3B. Regarding first‐line induction, a shift from R‐CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) to R‐bendamustine was observed over time, as well as a decline in radiotherapy. 2‐year progression‐free survival rates were 88.3% (95% confidence interval [CI] 84.0‐92.6) for first‐line patients and 76.0% (95% CI: 68.8‐83.3) for relapsed/refractory patients. Conversion from partial to complete remission (PR, CR) occurred in 53.4% of analyzed first‐line patients with PR, resulting in 69.4% CRs at study end (relapsed/refractory: conversion in 42.9%, final CRs 57.9%). Safety results were consistent with the known safety profile of rituximab in this setting. Both treatment‐naïve and relapsed/refractory patients with FL show favorable 2‐year PFS rates and improvements in the remission status with postinduction rituximab monotherapy as maintenance and consolidation therapy.

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“…In 2017, the US Food and Drug Administration (FDA) approved the combination of SC rituximab (rituximab plus rHuPH20) for adult patients with follicular lymphoma (FL), diffuse large B-cell lymphoma (DLBCL), and chronic lymphocytic leukemia (CLL) [ 12 ]. IV infusion times typically range from 1.5–4 hours but can be as long as 6 hours depending on the indication, dosing, and infusion history [ 13 , 14 ]. SC rituximab provides patients an option that considerably shortens administration times to approximately 5–7 minutes [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Assessing the transition from intravenous to subcutaneous delivery of rituximab: Benefits for payers, health care professionals, and patients with lymphoma

et al. 2022

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Subcutaneous (SC) administration of rituximab provides an opportunity for reduced patient treatment burden and increased healthcare efficiencies as an alternative to intravenous (IV) rituximab. There is minimal evidence comparing costs associated with SC and IV rituximab in a US setting. This research assessed the impact of transitioning patients from IV to SC rituximab for treatment of non-Hodgkin’s lymphoma (NHL) from the US payer, provider, and patient perspective. We developed a model to estimate cost differences for transitioning 20% of a patient cohort from IV to SC rituximab. We included patients with incident diffuse large B-cell lymphoma, incident and recurrent follicular lymphoma, and incident and recurrent chronic lymphocytic leukemia. In the model, each patient received the same number of doses and that there was no difference in discontinuation between cohorts due to non-inferior efficacy and a similar safety profile. Model inputs were collected from published literature and publicly available data. Scenario analyses tested the impact of availability of low-cost biosimilars. In the base case (1,000,000 covered lives), we estimated a total of 157 patients, with 769 total drug administrations. A transition of 20% of patients from IV to SC was projected to generate $153,000 in payer savings, increase provider capacity by 270 hours, and free 470 hours of patient time. Scenario analyses suggest SC administration will be cost saving for payers even with a market where biosimilars approach 50% market share. A 20% transition to SC rituximab in a single cohort of patients has the potential to generate significant US health system value in the form of payer savings, increased practice capacity, and patient time.

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Critical appraisal of rituximab in the maintenance treatment of advanced follicular lymphoma

Cited by 3 publications

References 87 publications

Risk factor analysis of autoimmune hemolytic anemia after allogeneic hematopoietic stem cell transplantation in children

Risk factor analysis of autoimmune hemolytic anemia after allogeneic hematopoietic stem cell transplantation in children

Rituximab maintenance therapy of follicular lymphoma in clinical practice

Assessing the transition from intravenous to subcutaneous delivery of rituximab: Benefits for payers, health care professionals, and patients with lymphoma

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