Ten patients were treated for relapse after previously having received rituximab therapy, and six of them responded to a second
course. The responders achieved a median increase in Hgb levels of 4.0 g/dL. The median time to response was 1.5 months (range, 0.5–4.0 months) and the median observed response duration was 11 months (range, 2–42 months). The treatment was well tolerated.87 Retrospectively, the results of rituximab monotherapy were also studied in the population-based descriptive study of 86 Norwegian patients.6 buy Vorinostat Forty patients were reported to have received rituximab monotherapy. As far as permitted by the retrospective design, the previously published response criteria (Table 4) were used for the data analysis. Twenty-three responders (58%) were identified; two (5%) achieved CR and 21 (53%) achieved PR. Responses were observed following a second and even a third course of rituximab in patients who had relapsed
after previous therapy.6 These findings confirm the essential results of the prospective studies; rituximab single agent therapy BIBW2992 mw is an efficient and well tolerated treatment for primary CAD. CR is uncommon, however; the median response duration is relatively short; and 40-50% of the patients do not respond. We wanted to improve on the results achieved by rituximab monotherapy. The purine nucleoside analogues, e.g. fludarabine, are powerful therapeutic agents in several lymphoproliferative diseases and remission of CAD has been observed in at least two patients after monotherapy with fludarabine.[6] and [89] Furthermore, Hydroxychloroquine combined treatment with fludarabine and rituximab has resulted in high response rates and sustained remissions in WM and other low-grade non-Hodgkin’s lymphoma.[90] and [91] We published in 2010 a prospective, uncontrolled trial of fludarabine and rituximab in combination in 29 patients with primary CAD requiring treatment.92 The median age was 73 years (range, 39–87 years). Eligible patients received rituximab 375 mg/m2 on days 1, 29, 57 and 85; and fludarabine
orally, 40 mg/m2 on days 1–5, 29–34, 57–61 and 85–89. Growth factors, co-trimoxazole or antiviral agents were not used routinely. Table 4 shows the response criteria. Responses were observed in 22 patients (76%); six (21%) achieved CR and 16 (55%) achieved PR. Ten patients had previously been non-responsive to rituximab monotherapy. In this subgroup, CR was observed in one patient and PR in six. Median increase in Hgb level was 3.1 g/dL in the responders and 4.0 g/dL among those who achieved CR. Median time to response was 4.0 months, and estimated median response duration was more than 66 months.92 Although comparison of non-randomized trials must be interpreted with caution, the much higher response rates, promising frequency of CR and very long response duration observed after the combination therapy compare favorably with the results achieved by rituximab monotherapy.
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