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Reply to Rituximab activity in CD20 positive multiple myeloma

Leukemia volume 21, pages 1842–1843 (2007)Cite this article

We read with great interest the paper by Moreau et al.1 on rituximab (anti-CD20 chimeric monoclonal antibody) activity in CD20+ multiple myeloma (MM). In particular, they treated 14 MM patients expressing CD20 on at least 33% of tumor cells either in untreated stage I or in stage III at relapse after two lines of chemotherapy. Only a single patient pretreated and expressing CD20 in 100% of cells experienced a minor response, and the rest did not respond. We would like to share our experience and make few comments since we recently treated one MM patient who achieved a complete response that was immunofixation negative following treatment with rituximab.

A 54-year-old male was diagnosed with MM IgG/k in April 2005 because of skeletal evidence of multiple osteolytic lesions after a preexistent 1 year diagnosis of monoclonal gammapathy of undetermined significance. At the time of progression to MM, bone marrow biopsy showed 50% monoclonal CD38+, CD138+ plasma cells infiltration; 100% were expressing CD20. Monoclonal component (MC) was 4.0 g/l, while serum calcium and creatinine were normal and β2-microglobulin was 2.3 mg/l. The patient was treated with thalidomide at the dose of 200 mg/day and pulsed dexamethasone administered at the dose of 40 mg/day on days 1–4, 9–12 and 17–20 (odd cycles) and 40 mg/day for 4 days on even cycles, repeated monthly for 4 months. Patient proceeded to PBSC collection in August 2005 after high-dose cyclophosphamide (7 g/m2) and granulocyte-colony stimulating factor (5 μg/kg/day). He underwent a first autologous stem cell transplant (ASCT) conditioned with melphalan 200 mg/m2 in October 2005. A bone marrow biopsy performed 3 months later still showed an infiltration of 30% of plasma cells and 2.1 g/l of serum MC. A second ASCT was performed in March 2006 preceded by melphalan 200 mg/m2. In June 2006 at bone marrow biopsy, 20% of plasma cells were still present, all of them expressing CD20 and a reduced but persistent MC in the serum. The patient was treated in July with rituximab 350 mg/m2/week for 4 weeks. A bone marrow biopsy in September 2006 showed less then 5% infiltration of polyclonal plasma cells with absent CD20. Serum IgG level is now 0.9 g/l, immunofixation is negative and the patient is still well in CR after 4 months of follow-up.

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References

  1. Moreau P, Voillat L, Benboukher L, Mathiot C, Dumontet C, Robillard N et al. Rituximab in CD20 positive multiple myeloma. Leukemia 2007; 21: 835–836.

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  2. Treon SP, Pilarski LM, Belch AR, Kelliher A, Preffer H, Shima Y et al. CD20-directed serotherapy in patients with multiple myeloma: biologic considerations and therapeutic applications. J Immunother 2002; 25: 72–81.

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Authors and Affiliations

  1. Department of Medicine and Immunological Sciences, Division of Hematology and Transplants, University of Siena, Siena, Italy

    A Gozzetti, A Fabbri, M Bocchia & F Lauria

  2. Department of Human Pathology and Oncology, University of Siena, Siena, Italy

    S Lazzi

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  1. A Gozzetti
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  2. A Fabbri
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  3. S Lazzi
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  4. M Bocchia
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  5. F Lauria
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Correspondence to A Gozzetti.

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Gozzetti, A., Fabbri, A., Lazzi, S. et al. Reply to Rituximab activity in CD20 positive multiple myeloma. Leukemia 21, 1842–1843 (2007). https://doi.org/10.1038/sj.leu.2404702

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