Indolent primary cutaneous B-cell lymphoma: Experience using systemic rituximab

doi:10.1016/j.jaad.2008.08.005

Journal of the American Academy of Dermatology

Volume 59, Issue 6, December 2008, Pages 953-957

https://doi.org/10.1016/j.jaad.2008.08.005 Get rights and content

Background

Optimal treatment of indolent primary cutaneous B-cell lymphoma (CBCL), marginal zone lymphoma, and follicle center lymphoma, presenting as multiple lesions, has yet to be established. Rituximab is a chimeric monoclonal IgG1 antibody directed against the CD20 antigen of B cells. Clinical efficacy of systemic rituximab in CBCL has yet to be established.

Objective

We sought to assess the efficacy of systemic rituximab in the treatment of CBCL.

Methods

This was a retrospective study of 15 patients with indolent CBCL treated with intravenous rituximab (375 mg/m²) as a single agent. Variable maintenance regimen was used in a subset of patients. Responses were categorized as complete response, partial response, stable disease, or progressive disease. The efficacy end points included were objective response rate, time to response, time to progression, and duration of response.

Results

Ten patients with follicle center lymphoma and 5 with marginal zone lymphoma were included. The objective response rate was 87% (60% complete response, 27% partial response). All patients with follicle center lymphoma had a response with 80% achieving complete response. Of the patients with marginal zone lymphoma, 3 had a response, one stable disease, and one progressive disease. Median follow-up was 36 months. Median time to response, duration of response, and time to progression was 30 days, 24 months, and 24 months, respectively.

Limitations

The study was limited by the small sample size and retrospective design.

Conclusions

This study, although small, suggests that rituximab is a reasonable first-line treatment option for indolent CBCL with multiple lesions where local treatment is not effective or desirable.

Section snippets

Patient selection

This study was a retrospective analysis of 15 patients with confirmed CBCL (FCL or MZL) treated between 2001 and 2008 with intravenous rituximab as a single agent. Twelve patients have been followed up at Stanford Comprehensive Cancer Center, Stanford, CA, and 3 at Memorial Sloan Kettering Cancer Center, New York, NY. The diagnoses were classified according to the joint WHO-EORTC classification,¹ and based on clinical, histologic, and immunohistochemical criteria. All patients included had CD20

Patient characteristics and treatment

Patient characteristics including sex, age at diagnosis, histology, previous therapy, skin tumor type and extent at time of treatment, number of intravenous treatments, best response, DOR, and follow-up are reported in Table I. Of the 15 patients with CBCL treated with rituximab, 5 patients had MZL and 10 patients had FCL (Table I). There were 7 female and 8 male patients with a median age of 51 years (22-79). Patients had either multiple lesions or involvement of the scalp (Table I).

Most

Discussion

The majority of primary CBCL (MZL and FCL) are indolent lymphomas that often can be managed with close observation or skin-directed therapy. Lesions that are painful, pruritic, disfiguring, or numerous usually require treatment. The standard approach for solitary or limited lesions is close observation or radiotherapy. In patients with multifocal skin disease or involvement of sites ill suited for radiation treatment (i.e. scalp), other treatment options, both skin-directed and systemic, have

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: Supported by the Stanford Cutaneous Lymphoma Research Fund.

: Disclosure: Dr Horwitz is a consultant for and receives honoraria from Genentech. Drs Morales, Advani, Reddy, Hoppe, and Kim, and Mr Riaz have no conflicts of interest to declare.

View full text

ReportIndolent primary cutaneous B-cell lymphoma: Experience using systemic rituximab

Background

Objective

Methods

Results

Limitations

Conclusions

Section snippets

Patient selection

Patient characteristics and treatment

Discussion

Blood

Radiother Oncol

Clin Lymphoma Myeloma

Blood

J Am Acad Dermatol

Ann Oncol

J Am Acad Dermatol

Blood

Primary cutaneous B-cell lymphoma: classification and treatment

Curr Opin Oncol

Primary cutaneous B-cell lymphomas treated with radiotherapy: a comparison of the European Organization for Research and Treatment of Cancer and the WHO classification systems

J Clin Oncol

A decade of rituximab: improving survival outcomes in non-Hodgkin's lymphoma

Annu Rev Med

CD20 antibody (C2B8)-induced apoptosis of lymphoma cells promotes phagocytosis by dendritic cells and cross-priming of CD8+ cytotoxic T cells

Leukemia

Monoclonal antibodies for B-cell lymphomas: rituximab and beyond (ASCO meeting)

Hematology

Rituximab-CHOP versus CHOP alone or with maintenance rituximab in older patients with diffuse large B-cell lymphoma

J Clin Oncol

Rituximab for follicular lymphoma

Curr Hematol Rep

Intralesional rituximab for cutaneous B-cell lymphoma

Br J Dermatol

Report
Indolent primary cutaneous B-cell lymphoma: Experience using systemic rituximab

CD20 antibody (C2B8)-induced apoptosis of lymphoma cells promotes phagocytosis by dendritic cells and cross-priming of CD8⁺ cytotoxic T cells