Chemoimmunotherapy Resistant Follicular Lymphoma – A Single Institutional Study
Cancer Research Journal
Volume 2, Issue 5, September 2014, Pages: 93-97
Received: Sep. 10, 2014;
Accepted: Sep. 17, 2014;
Published: Sep. 30, 2014
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Sampath Kumar-Kandala Jeevan, Department of Pathology, Nizam`s Institute of Medical Sciences, Hyderabad, India
Roshni Paul-Tara, Department of Pathology, Nizam`s Institute of Medical Sciences, Hyderabad, India
Shantiveer Uppin, Department of Pathology, Nizam`s Institute of Medical Sciences, Hyderabad, India
Megha Uppin, Department of Pathology, Nizam`s Institute of Medical Sciences, Hyderabad, India
Kavitha Bali, Department of Pathology, Osmania Medical College, Hyderabad, India
Sundaram- Challa, Department of Pathology, Nizam`s Institute of Medical Sciences, Hyderabad, India
Raghunadha Rao, Department of Medical Oncology, Nizam`s Institute of Medical Sciences, Hyderabad, India
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Follicular lymphoma (FL) is the most common indolent form of non Hodgkin lymphoma and characterized by initial response to treatment with inevitable relapse. Rituximab, is an anti CD20 monoclonal antibody, plays an important role in combination chemoimmunotherapy in treatment of symptomatic follicular lymphoma. Though rituximab is helpful in reducing the tumor burden in patients of follicular lymphoma, a significant proportion of patients were found to have resistance to rituximab and eventually progressed to high grade lymphoma. In this study we evaluated chemoimmunotherapy (CIR) resistant patients to know the incidence, predictive factors associated with CIR resistance and prognosis. This is a retrospective study, included 49 patients of follicular lymphoma, of these 12 (24.5%) demonstrated CIR resistance. On univariate analysis, high LDH values, advanced stage and high FLIPI score may predict the resistance of CIR therapy in initial stage of therapy. Overall, 7 patients (58.3%) progressed to high grade lymphoma (biopsy proven) and 2 (16.6%) died of disease progression in CIR resistant patients. Progressive free survival significantly reduced in CIR resistant patients (26 months) than CIR responders.
Chemoimmunotherapy Resistance, Follicular Lymphoma, FLIPI Score, Lactate Dehydrogenase, Advance Stage, Progression
To cite this article
Sampath Kumar-Kandala Jeevan,
Chemoimmunotherapy Resistant Follicular Lymphoma – A Single Institutional Study, Cancer Research Journal.
Vol. 2, No. 5,
2014, pp. 93-97.
Buske C, Gisselbrecht C, Gribben J, et al. Refining the treatment of follicular lymphoma: Leukemia and Lymphoma, 2008; 49:18-26.
Hiddemann W, Kneba M, Dreyling M, et al. – 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 lymphomas compared with therapy with CHOP alone: results of a prospective randomized study of the German Low-Grade Lymphoma Study Group. Blood, 2005; 106:3725-3732
Salles G, Seymour JF, Offner F et al. Rituximab maintenance for 2 years in patients with high tumour burden follicular lymphoma responding to rituximab plus chemotherapy (PRIMA): a phase 3, randomized controlled trial. Lancet 2011;377:42-51.
van Oers MH, Klasa R, Marcus RE et al. Rituximab maintenance improves clinical outcome of relapsed/resistant follicular non-Hodgkin lymphoma in patients both with and without rituximab during induction: results of a prospective randomized phase 3 intergroup trial. Blood 2006;108:3295-3301.
Marinus H.J, Van Oers MH, Van Glabbeke M et al. Rituximab maintenance treatment of relapsed/resistant follicular non-Hodgkin's lymphoma: long-term outcome of the EORTC 20981 phase III randomized intergroup study. J Clin Oncol 2010;28:2853-2858.
Golay J, Zaffaroni L, Vaccari T et al. Biologic response of B lymphoma cells to anti-CD20 monoclonal antibody rituximab in vitro: CD55 and CD59 regulate complement-mediated cell lysis. Blood 2000;95:3900-3908.
Macor P, Tripodo C, Zorzet S et al. In vivo targeting of human neutralizing antibodies against CD55 and CD59 to lymphoma cells increases the antitumor activity of rituximab. Cancer Res 2007;67:10556-10563.
Treon SP, Mitsiades C, Mitsiades N et al. Tumor cell expression of CD59 is associated with resistance to CD20 serotherapy in patients with B-cell malignancies. J Immunother 2001;24:263-271.
Czuczman MS, Olejniczak S, Gowda A et al. Acquirement of rituximab resistance in lymphoma cell lines is associated with both global CD20 gene and protein down-regulation regulated at the pretranscriptional and posttranscriptional levels. Clin Cancer Res 2008;14:1561-1570.
Itala M, Geisler CH, Kimby E et al. Standard-dose anti-CD20 antibody rituximab has efficacy in chronic lymphocytic leukaemia: results from a Nordic multicentre study. Eur J Haematol 2002; 69:129-134
Manches O, Lui G, Chaperot L et al. In vitro mechanisms of action of rituximab on primary non-Hodgkin lymphomas. Blood 2003; 101:949-954.
Cartron G, Dacheux L, Salles G et al. Therapeutic activity of humanized anti-CD20 monoclonal antibody and polymorphism in IgG Fc receptor FcgammaRIIIa gene. Blood 2002; 99:754-758.
Czuczman MS, Gregory SA. The future of CD20 monoclonal antibody therapy in B-cell malignancies. Leuk Lymphoma 2010; 51:983-994.
13. Al-Tourah AJ, Gill KK, Chhanabhai M et al. Population-based analysis of incidence and outcome of transformed non-Hodgkin's lymphoma.J Clin Oncol 2008;26:5165-5169.
Montoto S, Davies AJ, Matthews J et al. Risk and clinical implications of transformation of follicular lymphoma to diffuse large B-cell lymphoma. J Clin Oncol 2007; 25:2426-2433.
Bastion Y, Sebban C, Berger F et al. Incidence, predictive factors, and outcome of lymphoma transformation in follicular lymphoma patients. J Clin Oncol 1997; 15:1587-1594.
Solal-Celigny P, Roy P, Colombat P et al. Follicular lymphoma international prognostic index. Blood 2004; 104:1258-1265.
Swerdlow S, Campo E, Harris N et al. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. Lyon, France: IARC Press 2008.
L. Mozessohn, M.C. Cheung, M. Crump et al. Chemoimmunotherapy resistant follicular lymphoma: predictors of resistance, association with transformation and prognosis. Leukemia & lymphoma 2014 Jan: (doi:10.3109/10428194.2014.885513).
Hatake K, Terui. Rituximab resistance in B-cell lymphoma and its elimination. Gan to kagaku ryoho cancer & chemotherapy; 2009 Apr; 36 (4):548-51.