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1.
Rinsho Ketsueki ; 62(8): 1070-1076, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-34497193

RESUMO

The prognosis of patients with follicular lymphoma (FL) has improved over the last decades. However, most patients with FL will eventually relapse. The management of FL is mainly determined by clinical stage and tumor burden. For localized-stage patients, an involved-field radiation therapy is recommended. For advanced-stage low tumor burden patients, watchful waiting remains the standard treatment, whereas rituximab monotherapy may be an alternative option. Immuno-chemotherapy combined with rituximab maintenance has been the standard care for patients with high tumor burden. Recently, the novel anti-CD20 monoclonal antibody obinutuzumab was approved for the treatment of FL. Obinutuzumab with chemotherapy followed by obinutuzumab maintenance is considered one of the standard therapeutic options. After relapse or progression, it is necessary to consider a treatment strategy based on several disease-related, treatment-related, and patient-related factors. During the last decade, the development of biological knowledge and use of molecularly targeted agents offer new therapeutic perspectives with chemo-free strategies. This review highlights the current standards for the treatment of FL.


Assuntos
Antineoplásicos , Linfoma Folicular , Antineoplásicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica , Humanos , Linfoma Folicular/tratamento farmacológico , Recidiva Local de Neoplasia/tratamento farmacológico , Rituximab/uso terapêutico
2.
Rinsho Ketsueki ; 62(8): 1077-1084, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-34497194

RESUMO

Diffuse large B-cell lymphoma (DLBCL) is the most common type of malignant lymphoma affecting about 14,000 patients per year in Japan. Recent progress in molecular genetic investigation has clarified the underlying mechanism of this heterogeneous disease applied to therapeutic developments. R-CHOP therapy was established as a standard regimen for DLBCL and provides a cure in many patients. However, about 30-40% of patients still develop relapsed/refractory (R/R) disease. The development of effective treatments for R/R DLBCL patients is thus an urgent issue. The development of immunotherapy for intractable DLBCL patients such as anti-CD19 chimeric antigen receptor (CAR)-T therapy and bispecific T-cell engager (BiTE) has recently progressed. This new modality demonstrates efficacy in patients with resistance to conventional anticancer drugs. The advent of emerging immunotherapy is a paradigm shift in lymphoma treatment and is important for clinicians to catch up with these changes.


Assuntos
Linfoma Difuso de Grandes Células B , Receptores de Antígenos Quiméricos , Antígenos CD19 , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Humanos , Imunoterapia Adotiva , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Linfoma Difuso de Grandes Células B/terapia , Receptores de Antígenos Quiméricos/uso terapêutico , Rituximab/uso terapêutico
3.
Rinsho Ketsueki ; 62(8): 1229-1235, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-34497211

RESUMO

Helicobacter eradication therapy is the first-line therapy for patients with Helicobacter positive idiopathic thrombocytopenic purpura (ITP) in Japan. Indications for treatement in patients with Helicobacter negative, or post-Helicobacter eradicated ITP are platelet counts less than 20×106/l or severe bleeding. The first-line treatment for these patients is corticosteroids. Thrombopoietin receptor agonists (TPO-RAs), rituximab, and splenectomy are second-line treatments for patients with corticosteroid refractory ITP. The choice of a second-line treatment should be determined in consideration of the advantages and disadvantages of each treatment. TPO-RAs are effective in over 80% of patients; however, long-term administration is usually needed. Rituximab treatment ends in four weeks, but its durable response rate is relatively low. The durable response rate of splenectomy is relatively high; however, it causes long-term complications. Effective treatments for patients with ITP who are refractory to second-line treatments have not been established. Some novel drugs are under clinical trials, and a treatment strategy for these patients is expected to be established.


Assuntos
Púrpura Trombocitopênica Idiopática , Corticosteroides , Humanos , Contagem de Plaquetas , Púrpura Trombocitopênica Idiopática/tratamento farmacológico , Rituximab/uso terapêutico , Esplenectomia , Trombopoetina
6.
Am J Case Rep ; 22: e932704, 2021 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-34487513

RESUMO

BACKGROUND Here, we report the novel presentation of a factor VII inhibitor in association with a new diagnosis of splenic marginal zone lymphoma in a previously healthy 38-year-old woman. There are only 4 reported cases of factor VII inhibitors, none of which are secondary to a splenic marginal zone lymphoma. CASE REPORT Our patient, a 38-year-old woman, presented reporting increased abdominal swelling and early satiety. She was found to have pancytopenia, an elevated international normalized ratio (INR), normal partial thromboplastin time (PTT), and massive splenomegaly. Further investigation revealed a morphology and immunophenotype most consistent with splenic marginal zone lymphoma. A mixing study was unable to bring the INR into normal range after 60 min, confirming a factor VII inhibition. Therefore, the final diagnosis was primary splenic marginal zone lymphoma and secondary factor VII inhibitors. Owing to the elevated INR, both chemotherapy and splenectomy were avoided and we began a 4-week course of weekly rituximab infusions. After a second course of 4 treatments, there was a resolution of both the coagulopathy and the splenomegaly. At this point, the splenectomy was safely performed. Maintenance rituximab continued for 2 years. Our patient has now been in remission 12 years. CONCLUSIONS We successfully treated a rare factor VII inhibitor and its underlying splenic marginal zone lymphoma with rituximab immunotherapy. A complete response was documented by splenectomy. The patient's 12-year remission of both the lymphoma and the inhibitor helps to support the causative relationship between the lymphoma and the factor VII inhibitor.


Assuntos
Linfoma de Zona Marginal Tipo Células B , Neoplasias Esplênicas , Adulto , Fator VII , Feminino , Humanos , Linfoma de Zona Marginal Tipo Células B/tratamento farmacológico , Rituximab/uso terapêutico , Esplenectomia , Neoplasias Esplênicas/tratamento farmacológico
7.
Pan Afr Med J ; 38: 372, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34367451

RESUMO

Rituximab (RTX), a chimeric monoclonal anti-CD20 antibody has become part of the standard therapy for patients with CD20-expressing B-cell lymphoma and rheumatoid arthritis. After encouraging results with open studies in systemic lupus erythematosus (SLE), RTX has not shown its effectiveness in randomized controlled trials. However, its efficacy has been validated in renal, hematological, and neuropsychiatric disorders. Understanding the history of RTX in SLE would be instructive in the hydroxychloroquine (HCQ) saga in COVID-19. Three steps would be necessary and sufficient before definitively closing the debate: 1) determine the effective and safe dose of HCQ, as well as the minimum duration of treatment in COVID-19; 2) define the profile of patients in whom HCQ would be more likely to be effective (especially in asymptomatic patients and/or at the onset of the first signs of the disease) and 3) conduct one or more multicentre RCT to evaluate the efficacy and safety of HCQ in COVID-19 in SSA.


Assuntos
COVID-19/tratamento farmacológico , Hidroxicloroquina/uso terapêutico , Fatores Imunológicos/uso terapêutico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Rituximab/uso terapêutico , Humanos
8.
BMJ Case Rep ; 14(8)2021 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-34344651

RESUMO

As we are over a year into the COVID-19 pandemic, we have made many forward strides in therapeutics. These treatments, such as monoclonal antibodies, have help mitigate the detrimental and often fatal consequences of COVID-19. The current indication for the use of monoclonal antibodies is mild to moderate COVID-19 infection within 10 days of symptom onset in those who are at high risk of progression to severe disease. However, their role in patients with prolonged symptoms is not clear. We present a unique case of monoclonal antibodies use after 54 days of symptom onset in an immunosuppressed patient with persistent COVID-19 infection despite standard treatment. This case illustrates the potential use of monoclonal antibodies outside of the current recommended therapeutic window in immunosuppressed patients, who may have difficulty with viral clearance.


Assuntos
COVID-19 , Anticorpos Monoclonais/uso terapêutico , Humanos , Pandemias , Rituximab/uso terapêutico , SARS-CoV-2
9.
BMJ Open ; 11(8): e047713, 2021 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-34344678

RESUMO

OBJECTIVE: To evaluate the ability of fluorescence optical imaging (FOI) Xiralite in the discrimination between rheumatoid arthritis (RA) patients with and without need of rituximab (RTX) retherapy-in comparison to clinical, laboratory and musculoskeletal ultrasound parameters. PATIENTS AND METHODS: Patients with established RA were prospectively followed over 1 year by Disease Activity Score 28, patient's global disease activity (visual analogue scale 0-100 mm), C reactive protein and erythrocyte sedimentation rate, ultrasound seven joint (US7) score and FOI in phases 1-3 and automatically generated PrimaVista mode (PVM) at baseline (before RTX) and after 3, 6 and 12 months. The need for RTX retherapy was decided by the treating rheumatologist-blinded to imaging data. RESULTS: 31 patients (female 77.4%, mean age 60.1±11.4, mean disease duration 14.9±7.1 years) were included. Fourteen (45.2%) patients received RTX retherapy within 12 months. In the group with RTX retherapy, FOI in PVM mode was the only parameter that presented significant increase over time (ß: 0.40, 95% CI: 0.08 to 0.71, p=0.013)-compared with the group without retherapy. In the prediction model via ROC analysis, FOI in PVM reached the highest values of all imaging, clinical and laboratory parameters which was associated with retherapy over 1 year with an area under the curve (AUC) of 0.78 (OR: 0.84, 95% CI: 0.72 to 0.98, p=0.031). US7 GS synovitis score revealed similar association with an AUC of 0.73 (p=0.049). CONCLUSION: US7 GS synovitis score and FOI in PVM are able to discriminate between patients with and without need for RTX retherapy better than clinical and laboratory parameters.


Assuntos
Antirreumáticos , Artrite Reumatoide , Sinovite , Idoso , Antirreumáticos/uso terapêutico , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/tratamento farmacológico , Estudos de Coortes , Feminino , Humanos , Pessoa de Meia-Idade , Imagem Óptica , Rituximab/uso terapêutico
10.
J Med Case Rep ; 15(1): 431, 2021 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-34404459

RESUMO

BACKGROUND: It is extremely rare for primary non-Hodgkin's lymphomas to occur singly in the cranial vault. One case diagnosed as primary diffuse large B-cell lymphoma is reported, initially misdiagnosed as metastatic skull tumor, complicated with Trousseau syndrome. CASE DESCRIPTION: The patient was a 60-year-old Japanese woman with no particular previous medical history. In a head computed tomography examination for vertigo, bone destructive skull tumor covering the right frontal, parietal, and temporal bones was incidentally discovered. As positron emission tomography indicated an abnormal accumulation in the large intestine and multiple cerebral infarctions suspicious of Trousseau syndrome were observed on magnetic resonance images, a metastatic skull tumor due to colorectal cancer was first considered. However, various tumor markers were negative, and colonoscopic biopsy indicated no colorectal abnormality. After pathological examination of the resected tumor, it was diagnosed as diffuse large B-cell lymphoma. The tumor affected muscles and skin but did not develop in the brain or the dura mater. As further general examination revealed no other abnormalities, we considered that it was primary diffuse large B-cell lymphoma in the cranial vault associated with Trousseau syndrome. Treatment with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone and high-dose methotrexate reduced the residual lesion; coagulation abnormalities, which are frequently associated with Trousseau syndrome, also improved. CONCLUSIONS: Skull tumors can result from a variety of malignancies, and their diagnosis may be complicated with Trousseau syndrome. However, even in cases of a single lesion in the cranial vault without invasion of the central nervous system, diffuse large B-cell lymphoma should be considered as a differential diagnosis.


Assuntos
Linfoma Difuso de Grandes Células B , Linfoma não Hodgkin , Neoplasias Cranianas , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Ciclofosfamida/uso terapêutico , Doxorrubicina/uso terapêutico , Feminino , Humanos , Linfoma Difuso de Grandes Células B/diagnóstico , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Linfoma não Hodgkin/tratamento farmacológico , Pessoa de Meia-Idade , Rituximab/uso terapêutico , Neoplasias Cranianas/tratamento farmacológico , Osso Temporal , Vincristina/uso terapêutico
11.
Arthritis Res Ther ; 23(1): 211, 2021 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-34389040

RESUMO

BACKGROUND: Anti-drug antibodies (ADAs) can impact on the efficacy and safety of biologicals, today used to treat several chronic inflammatory conditions. Specific patient groups may be more prone to develop ADAs. Rituximab is routinely used for ANCA-associated vasculitis (AAV) and as off-label therapy for systemic lupus erythematosus (SLE), but data on occurrence and predisposing factors to ADAs in these diseases is limited. OBJECTIVES: To elucidate the rate of occurrence, and risk factors for ADAs against rituximab in SLE and AAV. METHODS: ADAs were detected using a bridging electrochemiluminescent (ECL) immunoassay in sera from rituximab-naïve (AAV; n = 41 and SLE; n = 62) and rituximab-treated (AAV; n = 22 and SLE; n = 66) patients. Clinical data was retrieved from medical records. Disease activity was estimated by the SLE Disease Activity Index-2000 (SLEDAI-2 K) and the Birmingham Vasculitis Activity Score (BVAS). RESULTS: After first rituximab cycle, no AAV patients were ADA-positive compared to 37.8% of the SLE patients. Samples were obtained at a median (IQR) time of 5.5 (3.7-7.0) months (AAV), and 6.0 (5.0-7.0) months (SLE). ADA-positive SLE individuals were younger (34.0 (25.9-40.8) vs 44.3 (32.7-56.3) years, p = 0.002) and with more active disease (SLEDAI-2 K 14.0 (10.0-18.5) vs. 8.0 (6.0-14), p = 0.0017) and shorter disease duration (4.14 (1.18-10.08) vs 9.19 (5.71-16.93), p = 0.0097) compared to ADA-negative SLE. ADAs primarily occurred in nephritis patients, were associated with anti-dsDNA positivity but were not influenced by concomitant use of corticosteroids, cyclophosphamide or previous treatments. Despite overall reduction of SLEDAI-2 K (12.0 (7.0-16) to 4.0 (2.0-6.7), p < 0.0001), ADA-positive individuals still had higher SLEDAI-2 K (6.0 (4.0-9.0) vs 4.0 (2.0-6.0), p = 0.004) and their B cell count at 6 months follow-up was higher (CD19 + % 4.0 (0.5-10.0) vs 0.5 (0.4-1.0), p = 0.002). At retreatment, two ADA-positive SLE patients developed serum sickness (16.7%), and three had infusion reactions (25%) in contrast with one (5.2%) serum sickness in the ADA-negative group. CONCLUSIONS: In contrast to AAV, ADAs were highly prevalent among rituximab-treated SLE patients already after the first course of treatment and were found to effect on both clinical and immunological responses. The high frequency in SLE may warrant implementations of ADA screening before retreatment and survey of immediate and late-onset infusion reactions.


Assuntos
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos , Lúpus Eritematoso Sistêmico , Corticosteroides , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/tratamento farmacológico , Ciclofosfamida , Humanos , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Rituximab/uso terapêutico
12.
Blood Adv ; 5(15): 2958-2964, 2021 08 10.
Artigo em Inglês | MEDLINE | ID: mdl-34338755

RESUMO

In 2017, the European Medicines Agency approved rituximab biosimilars (R-biosimilars) for treatment of diffuse large B-cell lymphoma (DLBCL). Thereafter, the Netherlands was one of the first countries to implement R-biosimilars, given lower costs compared with rituximab originator (R-originator). This study's objective was to investigate whether overall survival (OS) of patients with DLBCL receiving R-biosimilars is similar to patients treated with R-originator. DLBCL patients ≥18 years, diagnosed between 2014 and 2018, who received at least 1 cycle of rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) were identified in the Netherlands Cancer Registry. Patients were categorized into R-originator or R-biosimilars groups based on data from a central repository of the Dutch medicinal drug market. The primary end point was 3-year OS, defined as the time between diagnosis and all-cause death. By the end of 2018, 91% of purchased rituximab were biosimilars. In total, 4429 patients were identified with 876 in the R-biosimilars group and 3553 in the R-originator group. Patients in the R-biosimilars group less frequently received >6 cycles of R-CHOP compared with patients treated with R-originator (24% vs 30%, P = .003). The 3-year OS did not differ between patients treated with R-originator or R-biosimilars (73% vs 73%, P = .855). This was confirmed with a multivariable Cox regression analysis accounting for sex, age, International Prognostic Index score, and number of R-CHOP cycles. In conclusion, the 3-year OS is similar for patients treated with CHOP in combination with R-originator or R-biosimilars and, therefore, favors the use of R-biosimilars in DLBCL treatment management.


Assuntos
Medicamentos Biossimilares , Linfoma Difuso de Grandes Células B , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Medicamentos Biossimilares/uso terapêutico , Humanos , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Rituximab/uso terapêutico , Vincristina/uso terapêutico
13.
Zhongguo Shi Yan Xue Ye Xue Za Zhi ; 29(4): 1136-1140, 2021 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-34362493

RESUMO

OBJECTIVE: To evaluate the efficacy and safety of CHOP regimen based on doxorubicin hydrochloride liposome in the initial treatment of elderly patients with diffuse large B-cell lymphoma (DLBCL). METHODS: Thirty-one patients with DLBCL treated from January 1, 2012 to December 31, 2019 were analyzed retrospectively, their median age was 83 (71-95) years old, and all of them were in Ⅲ-Ⅳ stage, including 17 cases who had international prognostic index (IPI) ≥ 3. The patients were treated with R-CHOP and CHOP regimens based on doxorubicin hydrochloride liposome. The efficacy and safety were evaluated during and after treatment. RESULTS: A total of 219 chemotherapy cycles and 7 median cycles were performed in 31 patients. The overall response (OR) rate and complete remission (CR) rate was 80.7% (25/31) and 61.3% (19/31), respectively, as well as 2 cases (6.5%) stable, 4 cases (12.9%) progressive. The main toxicities were as follows: the incidence of grade Ⅲ -Ⅳ neutropenia was 29% (9/31); two patients (6.5%) developed degree Ⅰ-Ⅱ cardiac events, which were characterized by new degree Ⅰ atrioventricular block; there were no cardiac events requiring emergency treatment and discontinuation of chemotherapy. The 1-year, 2-year and 3-year overall survival rate was 83.9%, 77.4% and 61.3%, respectively. The 1-year, 2-year and 3-year progression-free survival rate was 77.4%, 64.5% and 61.3%, respectively. CONCLUSION: The chemotherapy regimen based on doxorubicin hydrochloride liposome has better efficacy and higher cardiac safety for elderly patients with DLBCL.


Assuntos
Lipossomos , Linfoma Difuso de Grandes Células B , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica , Ciclofosfamida/uso terapêutico , Doxorrubicina/uso terapêutico , Humanos , Lipossomos/uso terapêutico , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Prednisolona , Prednisona/uso terapêutico , Estudos Retrospectivos , Rituximab/uso terapêutico , Vincristina/uso terapêutico
14.
Zhongguo Shi Yan Xue Ye Xue Za Zhi ; 29(4): 1175-1180, 2021 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-34362499

RESUMO

OBJECTIVE: To investigate the clinical efficacy of high dose methotrexate (HD-MTX), temozolomide (TMZ), and rituximab (R) in the treatment of patients with primary central nervous system lymphoma (PCNSL). METHODS: Clinical data of patients with PCNSL diagnosed and treated in Guangdong Provincial People's Hospital from February 2010 to May 2017 were collected. First, patients were given 6-8 cycles of MTX (3.5 g/m2) for induction treatment, and then 12 cycles of TMZ (150 mg/m2) for maintenance treatment. The day before induction treatment, patients were given rituximab 375 mg/m2 according to their economic status. A retrospective cohort study was performed on patients receiving HD-MTX+TMZ or HD-MTX+TMZ+R to analyze the efficacy and survival. RESULTS: There were 42 patients enrolled in the study, 17 cases in HD-MTX+TMZ group and 25 cases in HD-MTX+TMZ+R group. The median PFS and OS times in HD-MTX+TMZ+R group were 56.7 months and N/A, respectively, while, 7.3 months and 34.7 months in HD-MTX+TMZ group, respectively. In addition, there was no significant difference in median survival between patients who received TMZ maintenance therapy and those who were only actively monitored. During the induction period, all the patients had grade 1-2 nausea and vomiting, while in the consolidation treatment period, no grade 3/4 toxicity was observed. CONCLUSION: The combination of HD-MTX+TMZ+R in the treatment of PCNSL patients shows a definite short-term effect, which can increase the survival rate of the patients. The side effects are mild, and the patients can generally tolerate.


Assuntos
Neoplasias do Sistema Nervoso Central , Linfoma não Hodgkin , Protocolos de Quimioterapia Combinada Antineoplásica , Sistema Nervoso Central , Neoplasias do Sistema Nervoso Central/tratamento farmacológico , Humanos , Linfoma não Hodgkin/tratamento farmacológico , Metotrexato/uso terapêutico , Estudos Retrospectivos , Rituximab/uso terapêutico , Temozolomida/uso terapêutico , Resultado do Tratamento
15.
Int J Mol Sci ; 22(16)2021 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-34445605

RESUMO

Coronavirus disease (COVID-19) is a contagious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This case report presents a patient who had difficulty eradicating the corona virus due to being treated with Rituximab, which depletes B lymphocyte cells and therefore disables the production of neutralizing antibodies. The combined use of external anti-viral agents like convalescent plasma, IVIG and Remdesivir successfully helped the patient's immune system to eradicate the virus without B-cell population recovery. In vitro studies showed that convalescent plasma is the main agent that helped in eradicating the virus.


Assuntos
Anticorpos Antivirais/imunologia , Linfócitos B/imunologia , COVID-19/tratamento farmacológico , COVID-19/imunologia , COVID-19/terapia , SARS-CoV-2/imunologia , Monofosfato de Adenosina/análogos & derivados , Alanina/análogos & derivados , Animais , Anticorpos Neutralizantes/uso terapêutico , Antivirais/uso terapêutico , COVID-19/diagnóstico por imagem , Chlorocebus aethiops , Humanos , Imunização Passiva , Hospedeiro Imunocomprometido , Rituximab/uso terapêutico , Linfócitos T/imunologia , Células Vero
17.
Curr Rheumatol Rep ; 23(9): 74, 2021 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-34269903

RESUMO

PURPOSE OF REVIEW: We reviewed the current data on infections associated with rituximab use published over the last 5 years. RECENT FINDINGS: New literature was available on rates of serious infections, Hepatitis B reactivation and screening, and infection with Severe Acute Respiratory Syndrome Coronavirus 2. Rates of infection varied by study and population, however, higher risk of infection in patients with underlying rheumatologic diseases was seen in those who required a therapy switch, had a smoking history, and those undergoing retreatment who had a serious infection with their first course of therapy. With regards to HBV, the proportion of patients screened continues to be inadequate. Despite the upfront cost, HBV screening and prophylaxis were found to be cost effective. There is still limited data regarding COVID-19 severity in the setting of rituximab, however, rituximab, especially in combination with steroids, may lead to more severe disease and higher mortality.


Assuntos
Antirreumáticos/uso terapêutico , COVID-19/epidemiologia , Hepatite B/epidemiologia , Infecções Oportunistas/epidemiologia , Rituximab/uso terapêutico , Antivirais/uso terapêutico , Hepatite B/diagnóstico , Hepatite B/tratamento farmacológico , Hepatite B/prevenção & controle , Humanos , Hospedeiro Imunocomprometido , Infecção Latente/diagnóstico , Infecção Latente/tratamento farmacológico , Infecção Latente/epidemiologia , Infecção Latente/prevenção & controle , Programas de Rastreamento , Risco , SARS-CoV-2 , Viroses/epidemiologia
18.
Rinsho Ketsueki ; 62(6): 631-640, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-34219091

RESUMO

Intravascular large B-cell lymphoma is a rare disease entity of extranodal large B-cell lymphoma and is characterized by selective growth of tumor cells in the lumina of small vessels in systemic organs. The challenge in obtaining sufficient tumor cells from biopsy specimens has hampered the elucidation of underlying biology. Recent advances in xenograft models and plasma cell-free DNA have revealed that the intravascular large B-cell lymphoma has genetic features similar to those of activated B-cell-like diffuse large B-cell lymphoma and frequent genetic alterations in immune-check point related genes. In terms of clinical aspects, considering the improvement in the clinical outcomes and higher risk of secondary central nervous system (CNS) involvement in the rituximab era, phase 2 trial of R-CHOP therapy combined with high-dose methotrexate and intrathecal chemotherapy as CNS-oriented therapy was conducted. The trial, named the PRIMEUR-IVL study, displayed good progression-free survival and low cumulative incidence of secondary CNS involvement. Further research is necessary to enable a deeper understanding of the pathophysiology of the disease and further improve the clinical outcomes.


Assuntos
Neoplasias do Sistema Nervoso Central , Linfoma Difuso de Grandes Células B , Protocolos de Quimioterapia Combinada Antineoplásica , Neoplasias do Sistema Nervoso Central/tratamento farmacológico , Ciclofosfamida/uso terapêutico , Doxorrubicina/uso terapêutico , Humanos , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Prednisona/uso terapêutico , Rituximab/uso terapêutico , Vincristina/uso terapêutico
19.
Rinsho Ketsueki ; 62(6): 641-648, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-34219092

RESUMO

Diffuse large B-cell lymphoma (DLBCL) is the most common lymphoma subtype, and nearly 70% of patients may be cured by administering R-CHOP therapy. However, R-CHOP is found to be inadequate in approximately one-third of the DLBCL cases, and refractory disease to R-CHOP is usually associated with a major cause of mortality. Therefore, it is essential to improve the efficacy of initial treatment in order to avoid unfavorable outcomes in patients with refractory DLBCL. In general, R-CHOP comprises of CHOP regimen that is repeated every 3 weeks and adding one-dose rituximab in each cycle. Although this combination method of rituximab with CHOP is effective and convenient, it does not contain enough scientific rationale and the schedule of rituximab administration has not been optimized. The pharmacokinetics of rituximab differs substantially among individuals and its serum half-life is approximately more than 500 hours; therefore, the peak concentration increases cumulatively by weekly infusion. A previous study revealed that patients with high blood concentration of rituximab showed higher response rate and longer progression-free survival. These findings suggest that the retention of higher levels of rituximab concentration and combination with chemotherapy during an early treatment period may bring about improvement of treatment effect. The HOVON group and Japan Clinical Oncology Group conducted randomized phase III studies to evaluate the efficacy of the dose-dense rituximab strategy for untreated DLBCL.


Assuntos
Linfoma Difuso de Grandes Células B , Linfoma não Hodgkin , Protocolos de Quimioterapia Combinada Antineoplásica , Ciclofosfamida/uso terapêutico , Doxorrubicina/uso terapêutico , Humanos , Japão , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Linfoma não Hodgkin/tratamento farmacológico , Prednisona/uso terapêutico , Rituximab/uso terapêutico , Resultado do Tratamento , Vincristina/uso terapêutico
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