Melanoma and Rituximab: An Incidental Association?

Peuvrel, L.; Chiffoleau, Anne; Quéreux, G.; Brocard, Anabelle; Saint‐Jean, M.; Batz, Arnaud; Jolliet, Pascale; Dréno, Brigitte

doi:10.1159/000350681

Cited by 25 publications

(21 citation statements)

References 19 publications

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“…However, several cases of 'rituximab-associated melanoma' have been reported: one case of metastatic melanoma occurring after rituximab-based therapy for an NHL and 15 additional rituximab-associated melanoma cases in 13 patients have been identified in the literature and in the EudraVigilance database in June 2012 [6].…”

Section: Discussionmentioning

confidence: 99%

Four cases of rituximab-associated melanoma

Velter¹,

Pagès²,

Schneider³

et al. 2014

Melanoma Research

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Biological agents have transformed the management of inflammatory and proliferative disorders. Safety issues have been raised, particularly the increased risk of opportunistic infections and secondary cancers. We report four cases of melanoma worsening or occurring after rituximab treatment for associated B-cell lymphoma, and discuss the accountability of the molecule in this process. In three cases, melanoma was diagnosed before or at the same time as a B-cell lymphoma treated with rituximab associated with chemotherapy and we observed rapid metastatic progression. In the last case, melanoma appeared after 5 years treatment with rituximab for a follicular lymphoma. Although it is premature to conclude on the role of rituximab in melanoma, careful follow-up and registration of such cases are important to gain further insight on this topic.

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Section: Discussionmentioning

confidence: 99%

Four cases of rituximab-associated melanoma

Velter¹,

Pagès²,

Schneider³

et al. 2014

Melanoma Research

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“…Until now, no known studies have addressed the use of rituximab as a first-line monotherapy in AIHA. In addition, there is evidence that rituximab causes, though rarely, severe side effects, including infections, serum sickness, acute respiratory distress, progressive multifocal leukoencephalopathy, and presumably induction of malignant lymphoma [ 42 , 43 , 44 , 45 , 46 ]. Moreover, follow-up studies exceeding 5 years are lacking, and long-term severe side effects cannot be excluded.…”

Section: Treatment Optionsmentioning

confidence: 99%

Treatment Options for Primary Autoimmune Hemolytic Anemia: A Short Comprehensive Review

Salama

2015

Transfus Med Hemother

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Until now, treatment of primary autoimmune hemolytic anemia of the warm type (wAIHA) is primarily based on immunosuppression. However, many patients do not respond adequately to treatment, and treated patients may develop severe side effects due to uncontrolled, mixed and/or long-lasting immunosuppression. Unfortunately, the newly used therapeutic monoclonal antibodies are unspecific and remain frequently ineffective. Thus, development of a specific therapy for AIHA is necessary. The ideal therapy would be the identification and elimination of the causative origin of autoimmunization and/or the correction or reprogramming of the dysregulated immune components. Blood transfusion is the most rapidly effective measure for patients who develop or may develop hypoxic anemia. Although some effort has been made to guide physicians on how to adequately treat patients with AIHA, a number of individual aspects should be considered prior to treatment. Based on my serological and clinical experience and the analysis of evidence-based studies, we remain far from any optimized therapeutic measures for all AIHA patients. Today, the old standard therapy using controlled steroid administration, with or without azathioprine or cyclophosphamide, is, when complemented with erythropoiesis-stimulating agents, still the most effective therapy in wAIHA. Rituximab or other monoclonal antibodies may be used instead of splenectomy in therapy-refractory patients.

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“…With patients achieving longer-term survival, management of subsequent primary malignancies (SPMs) is an emerging challenge. While rituximab-induced B-cell dysfunction and immunodeficiency may lead to increased susceptibility to infections and progression of malignancies (Chapel et al, 2003;Kaplan et al, 2014), there have been few reports of rituximab-related secondary cancers after DLBCL (Pfreundschuh, 2006;Solal-Celigny, 2006;Aksoy et al, 2011;Cho et al, 2015;Fleury et al, 2016;Hua et al, 2015), with the exception of two reports of melanoma acceleration after rituximab treatment (Peuvrel et al, 2013;Velter et al, 2014). A large Surveillance, Epidemiology, and End Results (SEER) analysis reported that DLBCL patients diagnosed 1992-2006 had 11% higher rate of overall SPMs than the general population, with particularly elevated risks for second primary Hodgkin lymphoma (HL) and certain leukaemias (Morton et al, 2010).…”

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confidence: 99%

Subsequent primary malignancies after diffuse large B‐cell lymphoma in the modern treatment era

Clarke

Rosenberg

et al. 2017

Br J Haematol

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Summary With the addition of rituximab and other treatment advances, survival after diffuse large B-cell lymphoma (DLBCL) has improved, but subsequent primary malignancies (SPMs) have emerged as an important challenge for DLBCL survivorship. We calculated standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) for SPMs among 23,879 patients who survived at least 1 year after a first primary DLBCL diagnosed during 1989–2012, compared to the general population in California. Cumulative incidence (CMI) of SPMs, accounting for the competing risk of death, also was calculated. We found that the incidence of acute myeloid leukaemia (AML) nearly doubled in the post-rituximab era [SIR (95%CI) 4.39 (2.51–7.13) pre- (1989–2000) and 8.70 (6.62–11.22) post-rituximab (2001–2012)]. Subsequent thyroid cancer was rare pre-rituximab, but increased substantially after 2001 [0.66 (0.08–2.37) vs. 2.27(1.44–3.41)]. The 5-year CMI for all SPMs (4.77% pre- vs. 5.41% post-rituximab, P=0.047), AML (0.15% vs. 0.41%, P=0.003), thyroid cancer (0.03% vs. 0.15%, P=0.003) and melanoma (0.25% vs. 0.42%, P=0.020) were greater in DLBCL patients diagnosed in the post-versus pre-rituximab period. This study provides insight into the changing pattern of SPM occurrence after the introduction of rituximab, which may elucidate the aetiology of SPMs and should guide future cancer surveillance efforts among DLBCL patients.

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Melanoma and Rituximab: An Incidental Association?

Cited by 25 publications

References 19 publications

Four cases of rituximab-associated melanoma

Four cases of rituximab-associated melanoma

Treatment Options for Primary Autoimmune Hemolytic Anemia: A Short Comprehensive Review

Subsequent primary malignancies after diffuse large B‐cell lymphoma in the modern treatment era

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