Treating chronic lymphocytic leukemia/small lymphocytic lymphoma with rituximab and high-dose methylprednisolone

This study aimed to investigate using rituximab (Rituxan) and high-dose methylprednisolone (HDMP; Medrol) as a treatment for chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL). This study concluded that this treatment is a good option for elderly and frail patients and can work as a bridge to other lines of treatment.  

CLL/SLL are cancers of immune cells called B cells. Many patients with CLL/SLL develop low blood cells counts caused by an overactive immune system. This complication is called autoimmune cytopenia. Corticosteroids such as MP can be used to reduce inflammation and stop an overactive immune system. However, many patients do not respond to corticosteroids alone.

Rituximab (R) is an immunotherapy. It increases the body's own immune responses to fight the cancer. The combination of R and HDMP is an older treatment option in patients with CLL/SLL. It may be useful for patients who are unfit for chemo-immunotherapy and also for those with autoimmune cytopenia. However, over time, the doses for the drugs and duration of treatment have been different. It is important to evaluate the effectiveness and safety of R-HDMP treatment in treating CLL/SLL, particularly in older and frail patients. 

This study involved 39 patients with CLL or SLL. The average age of patients was 77 years. Patients were treated with R-HDMP. They were followed up for an average of 30 months. 

Overall, 64% of patients responded to the treatment. 23% of patients had a complete response (complete disappearance of the cancer) . 41% had a partial response (tumor shrinkage). There was a similar response in patients treated with R-HDMP as a first-line treatment and those with relapsed disease. 

The average overall survival (OS) was 24 months and the average survival without cancer worsening was 13 months. 

9 patients were treated as a first-line treatment and were followed up for 54 months, on average. These patients had an average overall survival of 54 months and an average survival without cancer worsening of 14 months.  

61.5% of patients relapsed and 41% received another line of treatment after R-HDMP, with an average time to next treatment of 13.5 months. Of the patients that relapsed, 54% improved their fitness and were considered fit for chemo-immunotherapy. 

10.2% of patients experienced severe low levels of white blood cells that fight off infections (neutropenia). 17.9% of patients experienced severe low levels of blood platelets (thrombocytopenia). During treatment, 51.3% of patients had infections.  

This study concluded that R-HDMP is a good treatment option for elderly and frail patients with CLL/SLL. It can also work as a bridge to other lines of treatment such as chemo-immunotherapy.  

This study had a small number of participants and was based on medical records. It also did not have a comparison group. Further studies are needed to validate these results.