How the discovery of rituximab impacted the treatment of B-cell non-Hodgkin’s lymphomas

Figures & data

Figure 1 Structure of rituximab, a chimeric monoclonal antibody (~30% mouse origin and ~70% human origin).

Notes: The murine variable regions bind specifically to the CD20 antigen on malignant (as well as normal) B cells. The human constant regions allow human effector mechanisms.
Abbreviations: V_L, variable domain (light chain); V_H, variable domain (heavy chain); C_L, constant domain (light chain); C_H, constant domain (heavy chain).

Figure 2 The various mechanisms of action rituximab uses to kill B cells associated with NHL through binding of the CD20 antigen.

Note: Binding provokes one or more of the following mechanisms: CDC, ADCC, and/or apoptosis.
Abbreviations: NHL, non-Hodgkin’s lymphoma; CDC, complement-dependent cytotoxicity; ADCC, antibody-dependent cellular cytotoxicity.

Table 1 Three key clinical trials with rituximab in combination with CHOP for treatment of aggressive B-cell lymphomas

	Patient population	Regimen	Overall survival	Progression-free survival
Coiffier et al^Citation56	n=399 Previously untreated Aged 60–80 years	R-CHOP vs CHOP	70% vs 57%	57% vs 38%
Pfreundschuh et al^Citation58	n=824 Previously untreated Aged 18–60 years	R-CHOP-like chemotherapy vs CHOP-like chemotherapy	93% vs 84% (P=0.0001)	79% vs 59% (P<0.0001)
Habermann et al^Citation59	n=632 Previously untreated Aged >60 years	R-CHOP vs CHOP	Not reached	53% vs 46% (P=0.04)

Notes: Trials led to US Food and Drug Administration approval for its use in this context.^56,58,59 Adapted from Dotan E, Aggarwal C, Smith MR. Impact of rituximab (Rituxan) on the treatment of B-cell non-Hodgkin’s lymphoma. P T. 2010;35(3):148–157.¹⁷

Abbreviations: CHOP, cyclophosphamide–doxorubicin HCl–vincristine [Oncovin]–prednisone; R-CHOP, rituximab with CHOP.

CoiffierBLepageEBrièreJCHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphomaN Engl J Med2002346423524211807147

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PfreundschuhMTrümperLÖsterborgACHOP-like chemotherapy plus rituximab versus CHOP-like chemotherapy alone in young patients with good-prognosis diffuse large-B-cell lymphoma: a randomised controlled trial by the MabThera international trial (mint) groupLancet Oncol20067537939116648042

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HabermannTMWellerEAMorrisonVARituximab-CHOP versus CHOP alone or with maintenance rituximab in older patients with diffuse large B-cell lymphomaJ Clin Oncol200624193121312716754935

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DotanEAggarwalCSmithMRImpact of rituximab (Rituxan) on the treatment of B-cell non-Hodgkin’s lymphomaP T201035314815720442809

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