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Update in Hematology
- Joseph P. Catlett, MD; and
- Barbara M. Alving, MD
- From Washington Hospital Center, Washington, D.C.; and National Institutes of Health, Bethesda, Maryland.
2001-2002 Series: Update Sessions from ACP-ASIM's 2001 Annual Session
Margaret Ring Gillock, Editor/David A. Cramer, MD, Co-Editor/Paul T. Kefalides, MD, Co-Editor
In the past several years, there has been a veritable explosion of new and impressive treatments that not only will alter the management of leukemia and lymphoma but are expected to have far-reaching effects in general internal medicine. Target-specific drugs, including monoclonal antibodies and selective enzyme inhibitors—along with so-called designer drugs—have ushered in a new era in medicine. Examples in this Update are rituximab, a monoclonal antibody effective in non-Hodgkin lymphoma and the oral antileukemia drug STI-571. We also discuss advances in the following areas of hematology: self-management of oral anticoagulant therapy, understanding risks for venous thromboembolism in women during pregnancy and in postmenopausal women who are undergoing hormone replacement therapy, and management of patients with sickle-cell disease.
Applications of Rituximab
Rituximab Is an Effective Initial Systemic Treatment for Low-Grade Non-Hodgkin Lymphoma
Rituximab (Rituxan, Genentech, Inc., South San Francisco, California, and IDEC Pharmaceuticals Corp., San Diego, California) is a humanized murine monoclonal antibody directed against the CD20 antigen, which is expressed on B lymphocytes in more than 90% of patients with B-cell non-Hodgkin lymphoma. The binding of the antibody to CD20 antigen on malignant B cells in vitro (as well as normal B cells) results in cellular destruction through a combination of cell-mediated cytotoxicity and complement-dependent cell lysis. Rituximab also triggers programmed cell death (apoptosis), and some investigators believe that this may be the most important mechanism of in vivo cell death. Response rates have approached 50% in patients with low-grade non-Hodgkin lymphoma who are resistant to conventional chemotherapy, a population with few treatment options (1).
Hainsworth and colleagues evaluated a new patient group for rituximab: chemotherapy-naive patients. The authors infused rituximab (375 mg/m2) once per week for 4 weeks in patients with low-grade non-Hodgkin lymphoma who had never received chemotherapy. …
