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Chronic Lymphocytic Leukemia

Rituximab in combination with high-dose methylprednisolone for the treatment of chronic lymphocytic leukemia

A Corrigendum to this article was published on 16 December 2009

Abstract

We observed that high-dose methylprednisolone (HDMP) and rituximab was well tolerated and had promising activity when used in combination to treat patients with fludarabine-refractory chronic lymphocytic leukemia (CLL). This prompted us to evaluate the use of these agents in frontline therapy. A total of 28 patients with a median age of 65 years enrolled in this study. Patients received HDMP at 1 g/m2 each day for 3 days during each of the three 4-week cycles together with rituximab and prophylactic antimicrobial therapy. The treatment was well tolerated with few adverse events of grade III or higher. The overall response rate was 96% (N=27). Nine patients (32%) achieved a complete remission (CR), two of which were without detectable minimal residual disease (MRD). Six patients with MRD received consolidation with alemtuzumab; five of these patients achieved an MRD-negative CR. With over 3 years of follow-up median progression-free survival was 30.3 months with only 39% of patients requiring additional therapy, and an overall survival was 96%. This study demonstrates that HDMP and rituximab is an effective nonmyelosuppressive treatment combination for patients with CLL that warrants consideration particularly for patients with limited myeloid reserve that might not tolerate standard treatment regimens.

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Acknowledgements

We thank Monica Cook, Maryann Betty, Robier Aguillon and Feng He, MSc for assistance with data collection and analysis. This study was supported, in part, by National Institutes of Health Grant PO1-CA081534 (TJK and JEC), National Institutes of Health Grant K08-CA106 605–01 (JEC)

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Correspondence to T J Kipps.

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TJK and JEC designed, performed research, and wrote the paper. DFJ performed research, analyzed data, and wrote the paper. TJK, JEC, and DFJ treated the patients. JDS and SJ analyzed data and wrote the paper. JB performed research and treated the patients. LZR performed research.

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Castro, J., James, D., Sandoval-Sus, J. et al. Rituximab in combination with high-dose methylprednisolone for the treatment of chronic lymphocytic leukemia. Leukemia 23, 1779–1789 (2009). https://doi.org/10.1038/leu.2009.133

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