Annals of Oncology Advance Access originally published online on January 11, 2007
Annals of Oncology 2007 18(4):647-651; doi:10.1093/annonc/mdl467
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© 2007 European Society for Medical Oncology
hematologic malignancies |
Influence of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone on serologic parameters and clinical course in lymphoma patients with autoimmune diseases
1 Divisions of Bone Marrow Transplantation
2 Oncology
3 Hematology, Department of Internal Medicine 1, Medical University of Vienna
4 Division of Rheumatology, Department of Internal Medicine 3, Vienna, Austria
* Correspondence to: Dr S. Wöhrer, Division of Bone Marrow Transplantation, Department of Internal Medicine 1, Medical University of Vienna, Waehringerguertel 18-20, 1090, Vienna, Austria. Tel: +43-676-33-11-928; Fax: +43-1-40400-5712; E-mail: stefan.woehrer{at}meduniwien.ac.at
Background: As patients with B-cell lymphomas suffering from an underlying autoimmune condition undergoing therapy with the CD20 antibody rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) offer the unique possibility of monitoring effects of therapy on various rheumatologic parameters, we have evaluated serologic autoimmune markers and the clinical outcome of patients with autoimmune diseases (ADs) who received lymphoma treatment with R-CHOP during the course of their disease.
Patients and methods: We have retrospectively analysed 13 patients with non-Hodgkin's lymphoma who concurrently suffered from ADs and were treated with the R-CHOP regimen. Subjective parameters along with rheumatoid factor (RF) and antinuclear antibodies (ANA) were serially measured.
Results: The median levels of RF were 901 IU/ml [inter-quartile-range (IQR) 189–2520] before and 75 IU/ml (IQR 45–644) after therapy (P = 0.028). The median levels of ANA were 800 (IQR 140–2560) before and 100 (40–1280) after therapy (P = 0.027). Ten (77%) patients showed clinical improvement of their autoimmune symptoms, two (15%) reported no difference and one (7%) patient with rheumatoid arthritis-related worsening symptoms during therapy with R-CHOP. The autoimmune-related symptoms recurred after a median time of 7 weeks (IQR 6–8) in seven patients. In terms of lymphoma response, 11 patients achieved a complete remission and two a partial remission.
Conclusions: This analysis indicates that R-CHOP given for lymphoma treatment is also effective for therapy of concurrent rheumatoid diseases. Both rheumatoid parameters as well as clinical symptoms showed a significant decrease during treatment with this immunochemotherapy. The effects on the rheumatic diseases, however, seem to be of limited duration.
Key words: autoimmune diseases, lymphoma, R-CHOP, rituximab
Received for publication September 13, 2006. Accepted for publication November 15, 2006.