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Prepublished online as a Blood First Edition Paper on February 13, 2003; DOI 10.1182/blood-2002-08-2644.
Submitted August 29, 2002
Accepted January 23, 2003
Rituximab in Lymphocyte Predominant Hodgkin's Disease: Results of a Phase II Trial
Bradley C Ekstrand, Jennifer B Lucas, Steven M Horwitz, Zhen Fan, Sheila Breslin, Richard T Hoppe, Yasodha Natkunam, Nancy L Bartlett, and Sandra J Horning*
Medicine (Oncology), Stanford University School of Medicine, Stanford, CA, USA
Pathology, Stanford University School of Medicine, Stanford, CA, USA
Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
Medicine (Oncology), Washington University School of Medicine, St. Louis, MO, USA
* Corresponding author; email: sandra.horning{at}stanford.edu.
Lymphocyte predominant Hodgkin's disease (LPHD) is a unique clinical entity characterized by indolent nodal disease that tends to relapse after standard radiotherapy or chemotherapy. The malignant cells of LPHD are CD20+ and therefore rituximab may have activity with fewer late effects than standard therapy. In this phase II trial, 22 patients with CD20+ LPHD received four weekly doses of rituximab at 375 mg/m2. Ten patients had previously been treated for HD while 12 patients had untreated disease. All 22 patients responded to rituximab (OR 100%) with CR in 9 (41%), CRu in 1 (5%) and PR in 12 (54%). Acute treatment-related adverse events were minimal. With a median follow-up of 13 months, 9 patients had relapsed, and estimated median freedom from progression was 10.2 months. Progressive disease was biopsied in 5 patients: 3 had recurrent LPHD while 2 patients had transformation to large cell non-Hodgkin's lymphoma (LCL). All 3 patients with recurrent LPHD were retreated with rituximab, with a second CR seen in 1 patient and stable disease in 2. Rituximab induced prompt tumor reduction in each of 22 LPHD patients with minimal acute toxicity; however, based on the relatively short response duration seen in our trial and the concerns about transformation, rituximab should be considered investigational treatment for LPHD. Further clinical trials are warranted to determine the optimal dosing schedule of rituximab, the potential for combination treatment, and the possible relationship of rituximab treatment to the development of LCL.
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