Skip to main content
Erschienen in:

01.03.2007 | Leitthema

Rituximab zur Therapie des Non-Hodgkin-Lymphoms

verfasst von: PD Dr. M.J. Rummel

Erschienen in: Die Onkologie | Ausgabe 3/2007

Einloggen, um Zugang zu erhalten

Zusammenfassung

Rituximab ist der erste monoklonale Antikörper, der für die Behandlung des Non-Hodgkin-Lymphoms zugelassen wurde. Die Kombination Rituximab plus Chemotherapie ist der alleinigen Chemotherapie in allen bislang geprüften Indikationen eindeutig überlegen. Zur Primärtherapie des follikulären Lymphoms mit Rituximab plus Chemotherapie liegen jetzt 4 große randomisierte Studien vor, die alle eine statistisch signifikante und klinisch relevante Überlebensverlängerung durch die Kombination mit Rituximab zeigen konnten. In der Primärtherapie des follikulären Lymphoms ist die Kombination mit Rituximab deshalb heute Standard. Darüber hinaus zeigen 2 weitere Phase-III-Studien, dass mit Rituximab auch beim rezidivierten follikulären Lymphom eine Überlebensverlängerung zu erreichen ist. Zum einen durch eine kombinierte Rituximab-Chemotherapie-Induktionsbehandlung, zum anderen mit einer Rituximab-Erhaltungstherapie, die auch nach der Rituximab-Chemotherapie-Induktionsbehandlung hoch wirksam und sehr gut verträglich ist. Das Risiko zu sterben wird durch die Rituximab-Erhaltungstherapie halbiert. Damit ist Rituximab beim rezidivierten follikulären Lymphom sowohl zur Remissionsinduktion als auch zur Erhaltungstherapie die überlegene Therapieform. Auch beim diffus großzelligen B-Zell-Lymphom ist die Rituximab-Chemotherapie heute therapeutischer Standard. In 4 großen randomisierten Studien ist die Verbesserung der Heilungschancen klar dokumentiert worden. Dies gilt für alle Altersgruppen und für alle Risikogruppen. Lediglich die Zahl der Therapiezyklen und die Dosisdichte sind je nach Alter und Risikogruppe der Patienten verschieden.
Literatur
1.
Zurück zum Zitat McLaughlin P, Grillo-Lopez AJ, Link BK et al. (1998) Rituximab chimeric anti-CD20 monoclonal antibody therapy for relapsed indolent lymphoma: half of patients respond to a four-dose treatment program. J Clin Oncol 16: 2825–2833 McLaughlin P, Grillo-Lopez AJ, Link BK et al. (1998) Rituximab chimeric anti-CD20 monoclonal antibody therapy for relapsed indolent lymphoma: half of patients respond to a four-dose treatment program. J Clin Oncol 16: 2825–2833
2.
Zurück zum Zitat Horning SJ (1993) Natural history of and therapy for the indolent non-Hodgkin’s lymphomas. Semin Oncol 20: 75–88PubMed Horning SJ (1993) Natural history of and therapy for the indolent non-Hodgkin’s lymphomas. Semin Oncol 20: 75–88PubMed
3.
Zurück zum Zitat Marcus R, Imrie K, Belch A et al. (2004) CVP chemotherapy plus Rituximab compared with CVP as first-line treatment for advanced follicular lymphoma. Blood: prepublished online; DOI 10.1182/blood-2004–08–3175 Marcus R, Imrie K, Belch A et al. (2004) CVP chemotherapy plus Rituximab compared with CVP as first-line treatment for advanced follicular lymphoma. Blood: prepublished online; DOI 10.1182/blood-2004–08–3175
4.
Zurück zum Zitat Hiddemann W, Kneba M, Dreyling M et al. (2005) Frontline therapy with rituximab added to the combination of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) significantly improves the outcome for patients with advanced-stage follicular lymphoma compared with therapy with CHOP alone: results of a prospective randomized study of the German Low-Grade Lymphoma Study Group. Blood 106: 3725–3732CrossRefPubMed Hiddemann W, Kneba M, Dreyling M et al. (2005) Frontline therapy with rituximab added to the combination of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) significantly improves the outcome for patients with advanced-stage follicular lymphoma compared with therapy with CHOP alone: results of a prospective randomized study of the German Low-Grade Lymphoma Study Group. Blood 106: 3725–3732CrossRefPubMed
5.
Zurück zum Zitat Herold M, Haas A, Srock S et al. (2006) Addition of Rituximab to First-Line MCP Chemotherapy prolongs Survival in advanced follicular Lymphoma, ASH. Orlando, Blood 108: 169; (abstract 484) Herold M, Haas A, Srock S et al. (2006) Addition of Rituximab to First-Line MCP Chemotherapy prolongs Survival in advanced follicular Lymphoma, ASH. Orlando, Blood 108: 169; (abstract 484)
6.
Zurück zum Zitat Oers MH van, Klasa R, Marcus RE et al. (2006) Rituximab maintenance improves clinical outcome of relapsed/resistant follicular non-Hodgkin’s lymphoma, both in patients with and without rituximab during induction: results of a prospective randomized phase III intergroup trial. Blood 108 (10): 3295–3301CrossRefPubMed Oers MH van, Klasa R, Marcus RE et al. (2006) Rituximab maintenance improves clinical outcome of relapsed/resistant follicular non-Hodgkin’s lymphoma, both in patients with and without rituximab during induction: results of a prospective randomized phase III intergroup trial. Blood 108 (10): 3295–3301CrossRefPubMed
7.
Zurück zum Zitat Forstpointner R, Dreyling M, Repp R et al. (2004) The addition of rituximab to a combination of fludarabine, cyclophosphamide, mitoxantrone (FCM) significantly increases the response rate and prolongs survival as compared with FCM alone in patients with relapsed and refractory follicular and mantle cell lymphomas: results of a prospective randomized study of the German Low-Grade Lymphoma Study Group. Blood 104: 3064–3071CrossRefPubMed Forstpointner R, Dreyling M, Repp R et al. (2004) The addition of rituximab to a combination of fludarabine, cyclophosphamide, mitoxantrone (FCM) significantly increases the response rate and prolongs survival as compared with FCM alone in patients with relapsed and refractory follicular and mantle cell lymphomas: results of a prospective randomized study of the German Low-Grade Lymphoma Study Group. Blood 104: 3064–3071CrossRefPubMed
8.
Zurück zum Zitat Fisher RI, Gaynor ER, Dahlberg S et al. (1993) Comparison of a standard regimen (CHOP) with three intensive chemotherapy regimens for advanced non-Hodgkin’s lymphoma. N Engl J Med 328: 1002–1006CrossRefPubMed Fisher RI, Gaynor ER, Dahlberg S et al. (1993) Comparison of a standard regimen (CHOP) with three intensive chemotherapy regimens for advanced non-Hodgkin’s lymphoma. N Engl J Med 328: 1002–1006CrossRefPubMed
9.
Zurück zum Zitat Coiffier B, Lepage E, Briere J et al. (2002) CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med 346: 235–242CrossRefPubMed Coiffier B, Lepage E, Briere J et al. (2002) CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med 346: 235–242CrossRefPubMed
10.
Zurück zum Zitat Feugier P, Van Hoof A, Sebban C et al. (2005) Long-term results of the R-CHOP study in the treatment of elderly patients with diffuse large B-cell lymphoma: a study by the Groupe d’Etude des Lymphomes de l’Adulte. J Clin Oncol 23: 4117–4126 Feugier P, Van Hoof A, Sebban C et al. (2005) Long-term results of the R-CHOP study in the treatment of elderly patients with diffuse large B-cell lymphoma: a study by the Groupe d’Etude des Lymphomes de l’Adulte. J Clin Oncol 23: 4117–4126
11.
Zurück zum Zitat McKelvey EM, Gottlieb JA, Wilson HE et al. (1976) Hydroxyldaunomycin (Adriamycin) combination chemotherapy in malignant lymphoma. Cancer 38: 1484–1493CrossRefPubMed McKelvey EM, Gottlieb JA, Wilson HE et al. (1976) Hydroxyldaunomycin (Adriamycin) combination chemotherapy in malignant lymphoma. Cancer 38: 1484–1493CrossRefPubMed
12.
Zurück zum Zitat Pfreundschuh M, Trumper L, Kloess M et al. (2004) Two-weekly or 3-weekly CHOP chemotherapy with or without etoposide for the treatment of young patients with good-prognosis (normal LDH) aggressive lymphomas: results of the NHL-B1 trial of the DSHNHL. Blood 104: 626–633CrossRefPubMed Pfreundschuh M, Trumper L, Kloess M et al. (2004) Two-weekly or 3-weekly CHOP chemotherapy with or without etoposide for the treatment of young patients with good-prognosis (normal LDH) aggressive lymphomas: results of the NHL-B1 trial of the DSHNHL. Blood 104: 626–633CrossRefPubMed
13.
Zurück zum Zitat Pfreundschuh M, Trumper L, Kloess M et al. (2004) Two-weekly or 3-weekly CHOP chemotherapy with or without etoposide for the treatment of elderly patients with aggressive lymphomas: results of the NHL-B2 trial of the DSHNHL. Blood 104: 634–641CrossRefPubMed Pfreundschuh M, Trumper L, Kloess M et al. (2004) Two-weekly or 3-weekly CHOP chemotherapy with or without etoposide for the treatment of elderly patients with aggressive lymphomas: results of the NHL-B2 trial of the DSHNHL. Blood 104: 634–641CrossRefPubMed
14.
Zurück zum Zitat Lenz G, Dreyling M, Hoster E et al. (2005) Immunochemotherapy with rituximab and cyclophosphamide, doxorubicin, vincristine, and prednisone significantly improves response and time to treatment failure, but not long-term outcome in patients with previously untreated mantle cell lymphoma: results of a prospective randomized trial of the German Low Grade Lymphoma Study Group (GLSG). J Clin Oncol: JCO.2005.08.133 Lenz G, Dreyling M, Hoster E et al. (2005) Immunochemotherapy with rituximab and cyclophosphamide, doxorubicin, vincristine, and prednisone significantly improves response and time to treatment failure, but not long-term outcome in patients with previously untreated mantle cell lymphoma: results of a prospective randomized trial of the German Low Grade Lymphoma Study Group (GLSG). J Clin Oncol: JCO.2005.08.133
15.
Zurück zum Zitat Romaguera JE, Fayad L, Rodriguez MA et al. (2005) High rate of durable remissions after treatment of newly diagnosed aggressive mantle-cell lymphoma with rituximab plus hyper-CVAD alternating with rituximab plus high-dose methotrexate and cytarabine. J Clin Oncol 23: 7013–7023CrossRefPubMed Romaguera JE, Fayad L, Rodriguez MA et al. (2005) High rate of durable remissions after treatment of newly diagnosed aggressive mantle-cell lymphoma with rituximab plus hyper-CVAD alternating with rituximab plus high-dose methotrexate and cytarabine. J Clin Oncol 23: 7013–7023CrossRefPubMed
16.
Zurück zum Zitat Ghielmini M, Schmitz S-FH, Cogliatti S et al. (2005) Effect of single-agent rituximab given at the standard schedule or as prolonged treatment in patients with mantle cell lymphoma: a study of the Swiss Group for Clinical Cancer Research (SAKK). J Clin Oncol 23: 705–711CrossRefPubMed Ghielmini M, Schmitz S-FH, Cogliatti S et al. (2005) Effect of single-agent rituximab given at the standard schedule or as prolonged treatment in patients with mantle cell lymphoma: a study of the Swiss Group for Clinical Cancer Research (SAKK). J Clin Oncol 23: 705–711CrossRefPubMed
17.
Zurück zum Zitat Foussard C, Mounier N, Van Hoof A et al. (2006) Update of the FL2000 randomized trial combining rituximab to CHVP-Interferon in follicular lymphoma (FL) patients (pts). ASCO, Abstract 7508 Foussard C, Mounier N, Van Hoof A et al. (2006) Update of the FL2000 randomized trial combining rituximab to CHVP-Interferon in follicular lymphoma (FL) patients (pts). ASCO, Abstract 7508
18.
Zurück zum Zitat Schulz H, Skoetz N, Bohlius J et al. (2005) Does combined immunochemotherapy with the monoclonal antibody rituximab improve overall survival in the treatment of patients with indolent non-Hodgkin lymphoma? Preliminary results of a comprehensive meta-analysis. ASH, Abstract 351 Schulz H, Skoetz N, Bohlius J et al. (2005) Does combined immunochemotherapy with the monoclonal antibody rituximab improve overall survival in the treatment of patients with indolent non-Hodgkin lymphoma? Preliminary results of a comprehensive meta-analysis. ASH, Abstract 351
19.
Zurück zum Zitat Hochster H, Weller E, Gascoyne R, et al. (2005) Maintenance rituximab after CVP results in superior clinical outcome in advanced follicular lymphoma (FL): results of the E1496 phase III trial from the Eastern Cooperative Oncology Group and the Cancer and Leukemia Group B. ASH, Abstract 349 Hochster H, Weller E, Gascoyne R, et al. (2005) Maintenance rituximab after CVP results in superior clinical outcome in advanced follicular lymphoma (FL): results of the E1496 phase III trial from the Eastern Cooperative Oncology Group and the Cancer and Leukemia Group B. ASH, Abstract 349
20.
Zurück zum Zitat Habermann T M, Weller E A, Morrison VA et al. (2003) Phase III trial of Rituximab-CHOP (R-CHOP) vs. CHOP with a second randomization to maintenance rituximab (MR) or observation in patients 60 years of age and older with diffuse large B-cell lymphoma (DLBCL). ASH, Abstract 8 Habermann T M, Weller E A, Morrison VA et al. (2003) Phase III trial of Rituximab-CHOP (R-CHOP) vs. CHOP with a second randomization to maintenance rituximab (MR) or observation in patients 60 years of age and older with diffuse large B-cell lymphoma (DLBCL). ASH, Abstract 8
21.
Zurück zum Zitat Pfreundschuh M, Truemper L, Gill D et al. First analysis of the completed Mabthera International (MInT) trial in young patients with low-risk diffuse large B-cell lymphoma (DLBCL): addition of rituximab to a CHOP-like regimen significantly improves outcome of all patients with the identification of a very favorable subgroup with IPI=0 and no bulky disease. ASH, Abstract 157 Pfreundschuh M, Truemper L, Gill D et al. First analysis of the completed Mabthera International (MInT) trial in young patients with low-risk diffuse large B-cell lymphoma (DLBCL): addition of rituximab to a CHOP-like regimen significantly improves outcome of all patients with the identification of a very favorable subgroup with IPI=0 and no bulky disease. ASH, Abstract 157
22.
Zurück zum Zitat Pfreundschuh M, Kloess M, Zeynalova S (2006) Six vs. Eight Cycles of Bi-Weekly CHOP-14 with or without Rituximab for Elderly Patients with Diffuse Large B-Cell Lymphoma (DLBCL): Results of the Completed RICOVER-60 Trial of the German High-Grade Non-Hodgkin Lymphoma Study Group (DSHNHL). ASH, Abstract 205 Pfreundschuh M, Kloess M, Zeynalova S (2006) Six vs. Eight Cycles of Bi-Weekly CHOP-14 with or without Rituximab for Elderly Patients with Diffuse Large B-Cell Lymphoma (DLBCL): Results of the Completed RICOVER-60 Trial of the German High-Grade Non-Hodgkin Lymphoma Study Group (DSHNHL). ASH, Abstract 205
23.
Zurück zum Zitat Pfreundschuh M, Ho A, Wolf M et al. (2005) Treatment results of CHOP-21, CHOEP-21, MACOP-B and PMitCEBO with and without rituximab in young good-prognosis patients with agressive lymphomas: rituximab as an „equalizer“ in the MinT (MABTHERA International Trail Group) study. ASCO, Abstract 6529 Pfreundschuh M, Ho A, Wolf M et al. (2005) Treatment results of CHOP-21, CHOEP-21, MACOP-B and PMitCEBO with and without rituximab in young good-prognosis patients with agressive lymphomas: rituximab as an „equalizer“ in the MinT (MABTHERA International Trail Group) study. ASCO, Abstract 6529
24.
Zurück zum Zitat Dreyling MH, Forstpointner R, Ludwig W et al. (2005) Combined immuno-chemotherapy (R-FCM) results in superior remission rates and overall survival in recurrent follicular and mantle cell lymphoma - follow-up of a prospective randomized trial of the German Low Grade Lymphoma Study Group (GLSG). ASCO, Abstract 6528 Dreyling MH, Forstpointner R, Ludwig W et al. (2005) Combined immuno-chemotherapy (R-FCM) results in superior remission rates and overall survival in recurrent follicular and mantle cell lymphoma - follow-up of a prospective randomized trial of the German Low Grade Lymphoma Study Group (GLSG). ASCO, Abstract 6528
25.
Zurück zum Zitat Dreyling MH, Forstpointner R, Gramatzki M et al. (2006) Rituximab maintenance improves progression-free and overall survival rates after combined immuno-chemotherapy (R-FCM) in patients with relapsed follicular and mantle cell lymphoma: Final results of a prospective randomized trial of the German Low Grade Lymphoma Study Group (GLSG). ASCO, Abstract 7502 Dreyling MH, Forstpointner R, Gramatzki M et al. (2006) Rituximab maintenance improves progression-free and overall survival rates after combined immuno-chemotherapy (R-FCM) in patients with relapsed follicular and mantle cell lymphoma: Final results of a prospective randomized trial of the German Low Grade Lymphoma Study Group (GLSG). ASCO, Abstract 7502
Metadaten
Titel
Rituximab zur Therapie des Non-Hodgkin-Lymphoms
verfasst von
PD Dr. M.J. Rummel
Publikationsdatum
01.03.2007
Verlag
Springer-Verlag
Erschienen in
Die Onkologie / Ausgabe 3/2007
Print ISSN: 2731-7226
Elektronische ISSN: 2731-7234
DOI
https://doi.org/10.1007/s00761-007-1188-x

Weitere Artikel der Ausgabe 3/2007

Der Onkologe 3/2007 Zur Ausgabe

CME Weiterbildung • Zertifizierte Fortbildung

Supportivtherapie für bestrahlte Patienten

Neu im Fachgebiet Onkologie

Informierte Frauen neigen zu späterem Mammografie-Screening

Frauen in ihren 40ern, die über die Vor- und Nachteile des Mammografie-Screenings auf Brustkrebs informiert werden, neigen stärker dazu, den Screeningbeginn nach hinten zu verschieben. Die Mehrheit aber nähme das Angebot an, wie eine US-Studie zeigt.

Endometriose-Subtypen und das Risiko für Ovarialkarzinome

19.07.2024 Ovarialkarzinom Nachrichten

US-Kohortendaten sprechen dafür, dass verschiedene Endometrioseformen unterschiedlich mit dem Risiko für Ovarialkarzinome assoziiert sind. Besonders erhöht ist das Risiko offenbar bei tief infiltrierenden und ovariellen Endometrioseformen.

Die zelluläre Differenzierung wird wiederhergestellt

18.07.2024 Akute myeloische Leukämie Nachrichten

Ivosidenib von Servier ist ein Inhibitor der mutierten Isoform der Isocitrat-Dehydrogenase-1 (IDH1) und wird zur Behandlung von Patientinnen und Patienten mit neu diagnostizierter akuter myeloischer Leukämie (AML) eingesetzt. Die Substanz sorgt für die Wiederherstellung der zellulären Differenzierung.

Weißer Hautkrebs: Ein Update zu Diagnostik und Therapie

18.07.2024 Fortbildungswoche 2024 Kongressbericht

In der aktualisierten Version der S3-Leitlinie „Aktinische Keratose und Plattenepithelkarzinom der Haut“ gibt es neue Empfehlungen, unter anderem zu erweiterten Optionen bei aktinischer Keratose sowie zur systemischen und chirurgischen Behandlung von Plattenepithelkarzinomen. Ein Überblick.

Update Onkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.