Post-remission intervention with alemtuzumab or rituximab to eradicate minimal residual disease in chronic lymphocytic leukemia: where do we stand?

Abstract

The introduction of purine nucleoside analogs, later in combination with alkylating moieties and anti-CD20 immunotherapy, has profoundly improved the response rate and response duration in patients with chronic lymphocytic leukemia (CLL). The quality of clinical response following treatment may be improved to a level where residual leukemic cells become undetectable. As patients with this type of response appear to have extended survival rates, minimal residual disease (MRD) eradication is considered a new objective in CLL treatment with the aim of improving progression-free survival (PFS) and potentially overall survival (OS). This review therefore aims to overview the prognostic value of MRD eradication in CLL, the role of post-remission intervention with "passive" immunotherapy (alemtuzumab or rituximab) so as to eliminate persistent MRD or prevent MRD relapse, the impact of these strategies on disease-free survival and their possible adverse consequences. The data indicate a potential for post-remission alemtuzumab or rituximab to prolong PFS in CLL, although more investigations and longer follow-up are required before MRD-guided strategies can be recommended outside of clinical trials.

• Authors: Eric Van Den Neste, Rémi Letestu, Thérèse Aurran-Schleinitz, Loïc Ysebaert, Pierre Feugier, Stéphane Leprêtre, Caroline Dartigeas
• Journal: Leukemia & lymphoma (Leuk Lymphoma) Vol. 53 Issue 3 Pg. 362-70 (Mar 2012) ISSN: 1029-2403 [Electronic] United States
• PMID: 21854093 (Publication Type: Journal Article, Review)

Chemical References

• Antibodies, Monoclonal, Humanized
• Antibodies, Monoclonal, Murine-Derived
• Antigens, CD20
• Antineoplastic Agents
• Alemtuzumab
• Rituximab
• Cyclophosphamide
• Vidarabine
• fludarabine

Topics

• Agammaglobulinemia (chemically induced)
• Alemtuzumab
• Antibodies, Monoclonal, Humanized (adverse effects, therapeutic use)
• Antibodies, Monoclonal, Murine-Derived (administration & dosage, adverse effects, therapeutic use)
• Antigens, CD20 (immunology)
• Antineoplastic Agents (therapeutic use)
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Cyclophosphamide (administration & dosage, adverse effects, therapeutic use)
• Disease-Free Survival
• Humans
• Leukemia, Lymphocytic, Chronic, B-Cell (drug therapy, pathology, therapy)
• Neoplasm, Residual (drug therapy)
• Neutropenia (chemically induced)
• Remission Induction
• Rituximab
• Treatment Outcome
• Vidarabine (administration & dosage, adverse effects, analogs & derivatives, therapeutic use)