Účinnost monoklonální protilátkyanti-CD20 – rituximabu v léčbě folikulárníholymfomu

The efficiency of monoclonal antibody anti-CD20 – rituximab –in the treatment of folicular lymphoma

Rituximab is a chimeric monoclonal antibody anti-CD20. CD20 receptor is expressed on cells of manyB-lymphoproliferative diseases and is constantly presented on cells of follicular lymphoma. Theeffective mechanism is antibody- (ADCC) and complement-dependent cytotoxicity (CDC). There is alsoevidence of direct induction of apoptosis and inhibition of proliferation. The usual dosage of rituximabis 4x375mg/m2 in slow infusion, applied in weekly intervals. A synergism of rituximab with manycytostatics was demonstrated in vitro and also confirmed in clinical studies. Rituximab toxicity is verylow and manifests usually with a moderate allergic reaction in the course of administration of the firstinfusion. In monotherapy, rituximab leads in relapsing and resistent patients with follicular lymphomato 46-48 % of overall response (OR) and 2-6 % complete remission (CR), whereas in primary treatment,up to 70 % OR and 20 % CR have been reported. Immunochemotherapy (rituximab combinationwith chemotherapy) is even more efficient. The CHOP/rituximab regime reached 95-100 % OR and54-58 % CR, corresponding results have been described even after combinations of fludarabin regimewith rituximab. Rituximab was also administered in combination with different cytokines. The efficiencyof rituximab with IFNα was between 45-71 % OR, combination of rituximab with IL-2, IL-12 andG-CSF reached around 67-69 % OR. Rituximab is used as an efficient method of purging in vivo beforecollection of peripheral stem cells and in maintenance therapy after autologous transplantation ofperipheral stem cells.

Key words:
rituximab, mabthera, monoclonal antibodies, follicular lymphoma