Systemic therapy with cyclophosphamide and anti-CD20 antibody (rituximab) in relapsed primary cutaneous B-cell lymphoma: a report of 7 cases.

Abstract

Rituximab, a chimeric antibody directed against CD20, has a high therapeutic value in refractory/relapsed low-grade or follicular B-cell non-Hodgkin's lymphomas as a monotherapy or in combination with polychemotherapy. We sought to evaluate the clinical activity and toxicity of a schedule foreseeing the use of intravenous rituximab preceded by single-dose cyclophosphamide in the treatment of patients with primary cutaneous B-cell lymphoma who progressed and relapsed after chemotherapy. A total of 7 patients were treated; 4 had both cutaneous lesions and nodal or visceral involvement. All the patients had been previously treated with at least 1 standard chemotherapy regimen, and 4 with 2 or more, with a median response duration of 8 months. Immunohistochemistry on frozen sections was performed with monoclonal antibodies directed against CD20, CD55, and CD59 before rituximab treatment. The overall objective response rate was 85.7%, with a complete response in 5 patients; treatment was well tolerated in all cases. After a median follow-up of 13 months, 2 patients showed a cutaneous relapse. The response durations of the remaining patients who were disease-free are now 5, 7, 17, and 18 months. No relationship was found between CD55 and CD59 expression and the clinical outcome. Although a longer follow-up period is needed to confirm these data, our results are encouraging, particularly in terms of disease-free survival.