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Vannucchi G, Campi I, Covelli D, Currò N, Lazzaroni E, Palomba A, Soranna D, Zambon A, Fugazzola L, Muller I, Guastella C, Salvi M. Efficacy Profile and Safety of Very Low-Dose Rituximab in Patients with Graves' Orbitopathy. Thyroid 2021; 31:821-828. [PMID: 33234032 DOI: 10.1089/thy.2020.0269] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Rituximab (RTX), a chimeric human-murine anti-CD20 monoclonal antibody, has been used for treatment of active moderate-severe Graves' orbitopathy (GO) since 2004 as second-line therapy in patients unresponsive to intravenous steroids. We conducted an open-label prospective study (EUDRACT 2012-001980-53) in which patients were treated with a single infusion of only 100 mg RTX to analyze the efficacy and safety of this low dose. Methods: Seventeen patients, of whom nine had disease that was unresponsive to intravenous methylprednisolone and eight with newly diagnosed GO, were enrolled. Disease activity was assessed with the clinical activity score (CAS) and severity with a composite ophthalmic score. Long-term surgical treatment and quality of life were also assessed, as well as treatment-related adverse events. Results: Mean baseline CAS was 4.56 ± 0.96 and decreased to 1.25 ± 1.14 at 24 weeks (p = 0.001). Disease inactivation occurred within 24 weeks in >90% of patients and was unrelated to disease duration. Severity improved in about 60% of patients, with no relapses. All patients showed peripheral depletion of CD20+ and CD19+ cells at the end of RTX infusion (60 minutes). Two patients required surgical orbital decompression because of optic neuropathy (ON). Among adverse events observed, there was one patient who developed a cytokine release syndrome. Conclusions: A dose of 100 mg RTX is effective in patients with active moderate-severe GO. Low doses are better tolerated, expose patients to immune suppression for a shorter period of time, and are extremely cost effective, compared with higher doses. This dose, consistently with all other immunosuppressants, does not prevent the progression of GO to dysthyroid ON.
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Affiliation(s)
- Guia Vannucchi
- Endocrine and Metabolic Department, Istituto Auxologico Italiano IRCCS, Milano, Italy
| | - Irene Campi
- Endocrine and Metabolic Department, Istituto Auxologico Italiano IRCCS, Milano, Italy
| | - Danila Covelli
- Department of Clinical Sciences and Community Health, Graves' Orbitopathy Center, Endocrinology, Milan, Italy
| | - Nicola Currò
- Department of Ophthalmology, Fondazione IRCCS Cà Granda, Milan, Italy
| | - Elisa Lazzaroni
- Department of Clinical Sciences and Community Health, Graves' Orbitopathy Center, Endocrinology, Milan, Italy
| | - Andrea Palomba
- Division of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | | | - Antonella Zambon
- Division of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Laura Fugazzola
- Endocrine and Metabolic Department, Istituto Auxologico Italiano IRCCS, Milano, Italy
| | - Ilaria Muller
- Department of Clinical Sciences and Community Health, Graves' Orbitopathy Center, Endocrinology, Milan, Italy
| | - Claudio Guastella
- Department of Otolaryngology, Fondazione IRCCS Cà Granda, Milan, Italy
| | - Mario Salvi
- Department of Clinical Sciences and Community Health, Graves' Orbitopathy Center, Endocrinology, Milan, Italy
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Joly E, Rimond O, Salaun V, Comoz F, Morice C, Dompmartin A, Verneuil L. [Localized urticarial rituximab-induced reaction in primary cutaneous marginal zone B-cell lymphoma]. Ann Dermatol Venereol 2019; 147:50-52. [PMID: 31635943 DOI: 10.1016/j.annder.2019.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 04/02/2019] [Accepted: 09/04/2019] [Indexed: 11/26/2022]
Affiliation(s)
- E Joly
- Service de dermatologie, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen, France; Université de Caen Normandie, Medical School, 14000 Caen, France.
| | - O Rimond
- Service de dermatologie, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen, France
| | - V Salaun
- Service d'hématologie biologique, CHU de Caen, 14033 Caen, France
| | - F Comoz
- Service d'anatomie pathologie, CHU de Caen, 14033 Caen, France
| | - C Morice
- Service de dermatologie, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen, France
| | - A Dompmartin
- Service de dermatologie, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen, France; Université de Caen Normandie, Medical School, 14000 Caen, France
| | - L Verneuil
- Service de dermatologie, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen, France
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T-Cell-Rich Recurrence of Primary Cutaneous Follicle Center Lymphoma After Systemic Rituximab: A Diagnostic Pitfall. Am J Dermatopathol 2019; 42:e36-e40. [PMID: 31592859 DOI: 10.1097/dad.0000000000001544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report on a 74-year-old man with a cutaneous B-cell follicle center lymphoma, which was treated upfront with systemic rituximab and suffered several local relapses. The first of the local recurrences, 10 months after completion of treatment, was characterized by a dense T-cell infiltrate that obscured a minor population of B-cell lymphoma cells, suggesting a second primary cutaneous T-cell lymphoma. This represents a previously not reported diagnostic pitfall and underscores the importance of performing sequential biopsies when dealing with lymphoma recurrences in this setting.
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Lima M. Cutaneous primary B-cell lymphomas: from diagnosis to treatment. An Bras Dermatol 2016; 90:687-706. [PMID: 26560215 PMCID: PMC4631235 DOI: 10.1590/abd1806-4841.20153638] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Accepted: 06/05/2014] [Indexed: 12/19/2022] Open
Abstract
Primary cutaneous B-cell lymphomas are a heterogeneous group of mature B-cells neoplasms with tropism for the skin, whose biology and clinical course differ significantly from the equivalent nodal lymphomas. The most indolent forms comprise the primary cutaneous marginal zone and follicle center B-cell lymphomas that despite the excellent prognosis have cutaneous recurrences very commonly. The most aggressive forms include the primary cutaneous large B-cell lymphomas, consisting in two major groups: the leg type, with poor prognosis, and others, the latter representing a heterogeneous group of lymphomas from which specific entities are supposed to be individualized over time, such as intravascular large B-cell lymphomas. Treatment may include surgical excision, radiotherapy, antibiotics, corticosteroids, interferon, monoclonal antibodies and chemotherapy, depending on the type of lymphoma and on the type and location of the skin lesions. In subtypes with good prognosis is contraindicated overtreatment and in those associated with a worse prognosis the recommended therapy relies on CHOP-like regimens associated with rituximab, assisted or not with local radiotherapy. We review the primary cutaneous B-cell lymphomas, remembering the diagnostic criteria, differential diagnosis, classification, and prognostic factors and presenting the available therapies.
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Affiliation(s)
- Margarida Lima
- Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal
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6
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Fernández-Guarino M, Ortiz-Romero P, Fernández-Misa R, Montalbán C. Rituximab in the Treatment of Primary Cutaneous B-Cell Lymphoma: A Review. ACTAS DERMO-SIFILIOGRAFICAS 2014. [DOI: 10.1016/j.adengl.2014.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Ingen-Housz-Oro S, Ortonne N, Chosidow O. Rituximab-related urticarial reaction overlying primary cutaneous follicle centre lymphoma: histological appearance and pathophysiological hypotheses. J Eur Acad Dermatol Venereol 2013; 28:976-8. [DOI: 10.1111/jdv.12313] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 10/09/2013] [Indexed: 11/28/2022]
Affiliation(s)
| | - N. Ortonne
- Department of Pathology; AP-HP; Henri Mondor Hospital; Créteil France
- Université Paris-Est Créteil Val de Marne UPEC; Créteil France
| | - O. Chosidow
- Department of Dermatology; AP-HP; Henri Mondor Hospital; Créteil France
- Université Paris-Est Créteil Val de Marne UPEC; Créteil France
- INSERM; Centre d'Investigation Clinique 006; Créteil France
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Fernández-Guarino M, Ortiz-Romero PL, Fernández-Misa R, Montalbán C. Rituximab in the treatment of primary cutaneous B-cell lymphoma: a review. ACTAS DERMO-SIFILIOGRAFICAS 2013; 105:438-45. [PMID: 23540593 DOI: 10.1016/j.ad.2012.10.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Revised: 10/24/2012] [Accepted: 10/25/2012] [Indexed: 11/16/2022] Open
Abstract
Rituximab is a chimeric mouse-human antibody that targets the CD20 antigen, which is found in both normal and neoplastic B cells. In recent years, it has been increasingly used to treat cutaneous B-cell lymphoma and is now considered an alternative to classic treatment (radiotherapy and surgery) of 2 types of indolent lymphoma, namely, primary cutaneous follicle center lymphoma and primary cutaneous marginal zone B-cell lymphoma. Rituximab is also administered as an alternative to polychemotherapy in the treatment of primary cutaneous large B-cell lymphoma, leg type. Its use as an alternative drug led to it being administered intralesionally, with beneficial effects. In the present article, we review the literature published on the use of rituximab to treat primary cutaneous B-cell lymphoma.
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Affiliation(s)
- M Fernández-Guarino
- Servicio de Dermatología, Hospital Central de la Cruz Roja, Universidad Alfonso X El Sabio, Madrid, España.
| | - P L Ortiz-Romero
- Facultad de Medicina, Universidad Complutense, Instituto i+12, Hospital Universitario 12 de Octubre, Madrid, España
| | - R Fernández-Misa
- Servicio de Dermatología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España
| | - C Montalbán
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Madrid, España
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