How effective and safe is biological therapy rituximab for children with non-Hodgkin lymphoma?

This study examined if adding biological therapy rituximab (Rituxan) to chemotherapy improved treatment results for children with non-Hodgkin lymphoma. The results showed that rituximab improved patients’ chances of survival but also caused more side effects.

Treatment results for children with NHL have significantly improved in recent times. The majority of children who receive chemotherapy, such as LMB (lymphomes malins B), will be cured. In adults with NHL, the addition of rituximab to chemotherapy has further improved treatment results. This can only be done for certain subtypes of NHL. It is unclear if adding rituximab to chemotherapy for children with NHL will improve treatment effectiveness while not significantly increasing side effects.

328 children with NHL were divided into two groups. 164 patients received LMB chemotherapy and 164 patients received LMB chemotherapy and rituximab. 85.7% of patients had NHL subtype Burkitt’s lymphoma. Patients’ results were recorded for an average of 39.9 months.

Rituximab increased patients’ chances of surviving by 64%. After 3 years, 95.1% of patients in the chemotherapy+rituximab group and 87.3% of patients in the chemotherapy alone group had survived.

Rituximab increased patients’ chances of surviving without NHL becoming worse by 68%. After 3 years, 93.9% of patients in the chemotherapy+rituximab group and 82.3% of patients in the chemotherapy alone group survived without NHL becoming worse.

37.7% of patients in the chemotherapy+rituximab group and 32.7% of patients in the chemotherapy alone group developed serious side effects. The most common side effects were fever with low white blood cells, infection, and mouth sores.

Antibodies are part of the immune system that helps fight infections. Following treatment, 70.3% of the chemotherapy+rituximab group and 46.8% of the chemotherapy alone group had low levels of antibodies. After 1 year, 55.9% of the chemotherapy+rituximab group and 25.4% of the chemotherapy alone group still had low antibody levels. Antibody transfusions were given to 15.8% of the chemotherapy+rituximab group and 7% of the chemotherapy alone group.

The authors concluded that the addition of rituximab to chemotherapy improved treatment results for children with high-risk NHL.

The majority of patients had NHL subtype Burkitt’s lymphoma so results may need to confirm for other NHL subtypes. This study would benefit from examining results over a longer period.