Summary:
Rituximab is used for in vivo tumor cell purging for non-Hodgkin's lymphoma (NHL) patients prior to autologous peripheral blood stem cell transplantation (PBSCT). However, its effects on PBSC mobilization and function are poorly understood. We compared the mobilization characteristics and engraftment kinetics of 13 NHL patients receiving and 34 NHL patients not receiving rituximab 6 months before PBSC mobilization. In the rituximab group, there was a significantly longer time to neutrophil engraftment (P=0.0466), a trend toward the need for BM harvest to supplement low-yield PBSC collections (31 vs 9%, P=0.08) and a significantly increased rate of bacteremia episodes (62 vs 26%, P=0.025). Median progression-free survival (PFS) and overall survival (OS) were significantly longer in the rituximab compared to the nonrituximab patients (P=0.049 and 0.042, respectively). However, patients in the nonrituximab group were at high risk for recurrence and expected to have shorter survival. Rituximab used within 6 months prior to collection may have a detrimental effect on PBSC mobilization and engraftment. However, rituximab is a major therapeutic breakthrough for NHL treatment and this negative effect may be offset by improved survival. Further studies are warranted in larger populations to determine the impact of rituximab on engraftment, PFS and OS.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Mink SA, Armitage JO . High-dose therapy in lymphomas: a review of the current status of allogeneic and autologous stem cell transplantation in Hodgkin's disease and non-Hodgkin's lymphoma. Oncologist 2001; 6: 247–256.
Hahn T, Wolff SN, Czuczman M et al. The role of cytotoxic therapy with hematopoietic stem cell transplantation in the therapy of diffuse large cell B-cell non-Hodgkin's lymphoma: an evidence-based review. Biol Blood Marrow Transplant 2001; 7: 308–331.
Grillo-Lopez AJ, Hedrick E, Rashford M, Benyunes M . Rituximab: ongoing and future clinical development. Semin Oncol 2002; 29 (1 Suppl 2): 105–112.
Grillo-Lopez AJ, White CA, Varns C et al. Overview of the clinical development of rituximab: first monoclonal antibody approved for the treatment lymphoma. Semin Oncol 1999; 26: 66–73.
Davis TA, White CA, Grillo-Lopez AJ et al. Single-agent monoclonal antibody efficacy in bulky non-Hodgkin's lymphoma: results of a phase II trial of Rituximab. J Clin Oncol 1999; 17: 1851–1857.
Czuczman MS, Grillo-Lopez AJ, White CA et al. Treatment of patients with low-grade B-cell lymphoma with the combination of chimeric anti-CD20 monoclonal antibody and CHOP chemotherapy. J Clin Oncol 1999; 17: 268–276.
Buckstein R, Imrie K, Spaner D et al. Stem cell function and engraftment is not affected by ‘in vivo purging’ with rituximab for autologous stem cell treatment for patients with low-grade non-Hodgkin's lymphoma. Semin Oncol 1999; 26 (5 Suppl 14): 115–122.
Flinn IW, O'Donnel PV, Goodrich A et al. Immunotherapy with rituximab during peripheral blood stem cell transplantation for non-Hodgkin's lymphoma. Biol Blood Marrow Transplant 2000; 6: 628–632.
Magni M, Nicola M, Devizzi L et al. Successful in vivo purging of CD34-containing peripheral blood harvests in mantle cell and indolent lymphoma: evidence for a role of both chemotherapy and rituximab infusion. Blood 2000; 96: 864–869.
Ladetto M, Zallio F, Vallet S et al. Concurrent administration of high-dose chemotherapy and rituximab is feasible and effective chemo/immunotherapy for patients with high-risk non-Hodgkin's lymphoma. Leukemia 2001; 15: 1941–1949.
Lazzarino M, Arcaini L, Bernasconi P et al. A sequence of immunochemotherapy with Rituximab, mobilization of in vivo purged stem cells, high-dose chemotherapy and autotransplant is an effective and non-toxic treatment for advanced follicular and mantle cell lymphoma. Br J Haematol 2002; 116: 229–235.
Schmitz N . Rituximab in autologous stem cell transplantation for follicular lymphoma. Anticancer Drugs 2001; 12 (Suppl 2): S21–S24.
Flinn IW, Lazarus HM . Monoclonal antibodies and autologous stem cell transplantation for lymphoma. Bone Marrow Transplant 2001; 27: 565–569.
Visani G, Lemoli RM, Tosi P et al. Fludarabine-containing regimens severely impair peripheral blood stem cells mobilization and collection in acute myeloid leukaemia patients. Br J Haematol 1999; 105: 775–779.
Laszlo D, Galieni P, Raspadori D et al. Fludarabine-containing regimens may adversely affect peripheral blood stem cell collection in low-grade non-Hodgkin lymphoma patients. Leuk Lymphoma 2000; 37: 157–161.
Ketterer N, Salles G, Moullet I et al. Factors associated with successful mobilization of peripheral blood progenitor cells in 200 patients with lymphoid malignancies. Br J Haematol 1998; 103: 235–242.
Nabholtz JM, Cantin J, Chang J et al. Phase III trial comparing granulocyte colony-stimulating factor to leridistim in the prevention of neutropenic complications in breast cancer patients treated with docetaxel/doxorubicin/cyclophosphamide: results of the BCIRG 004 trial. Clin Breast Cancer 2002; 3: 268–275.
Kaplan EL, Meier P . Nonparametric estimation for incomplete observations. J Am Stat Assoc 1958; 53: 457–481.
Bensinger W, Appelbaum F, Rowley S et al. Factors that influence collection and engraftment of autologous peripheral blood stem cells. J Clin Oncol 1995; 13: 2547–2555.
Foran JM, Rohatiner AZ, Cunningham D et al. European phase II study of rituximab (chimeric anti-CD20 monoclonal antibody) for patients with newly diagnosed mantle-cell lymphoma and previously treated mantle-cell lymphoma, immunocytoma, and small B-cell lymphocytic lymphoma. J Clin Oncol 2000; 18: 317–324.
Coiffier B, Lepage E, Briere J et al. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med 2002; 346: 235–242.
Benekli M, Shafi F, Qureshi A et al. The effect of rituximab on peripheral blood stem cell mobilization in non-Hodgkin's lymphoma. Proc Am Soc Clin Oncol 2002; 21: 417a (Abstract).
Blum KA, Hidalgo J, Khoury H et al. Delayed neutrophil and platelet engraftment following autologous transplantation in non-Hodgkin's lymphoma patients previously treated with rituximab. Blood 2002; 100: 643a (Abstract).
Liszewski MK, Farries TC, Lublin DM et al. Control of the complement system. Adv Immunol 1996; 61: 201–283.
Bienvenu J, Chvetzoff R, Salles G et al. Tumor necrosis factor alpha release is a major biological event associated with rituximab treatment. Hematol J 2001; 2: 378–384.
van der Kolk LE, Grillo-Lopez AJ, Baars JW et al. Complement activation plays a key role in the side-effects of rituximab treatment. Br J Haematol 2001; 115: 807–811.
Nagler A, Or R, Nisman B et al. Elevated inflammatory cytokine levels in bone marrow graft rejection. Transplantation 1995; 60: 943–948.
Acknowledgements
We wish to acknowledge the support of the staff of the Stem Cell Processing and Flow Cytometry Laboratories, and Therapeutic Apheresis, the clinical staff who cared for these patients, and the editorial assistance of Ms Dorothy Macchio.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Benekli, M., Hahn, T., Shafi, F. et al. Effect of rituximab on peripheral blood stem cell mobilization and engraftment kinetics in non-Hodgkin's lymphoma patients. Bone Marrow Transplant 32, 139–143 (2003). https://doi.org/10.1038/sj.bmt.1704106
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.bmt.1704106
Keywords
This article is cited by
-
Autologous peripheral blood stem cell mobilization following dose-adjusted cyclophosphamide, doxorubicin, vincristine, and prednisolone chemotherapy alone or in combination with rituximab in treating high-risk non-Hodgkin’s lymphoma
Chinese Journal of Cancer (2015)
-
Novel agents and approaches for stem cell mobilization in normal donors and patients
Bone Marrow Transplantation (2012)
-
How to determine post-RCHOP therapy for risk-tailored adult patients with diffuse large B-cell lymphoma, addition of maintenance rituximab or observation: multicenter experience
Journal of Cancer Research and Clinical Oncology (2012)
-
A randomized trial of etoposide and G-CSF with or without rituximab for PBSC mobilization in B-cell non-Hodgkin's lymphoma
Bone Marrow Transplantation (2009)
-
Rituximab does not compromise the mobilization and engraftment of autologous peripheral blood stem cells in diffuse-large B-cell lymphoma
Bone Marrow Transplantation (2007)