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Randomised comparison of two B‐cell purging protocols for patients with B‐cell non‐Hodgkin lymphoma: in vivo purging with rituximab versus ex vivo purging with CliniMACS CD34 + cell enrichment device
Author(s) -
Heeckeren Willem J.,
Vollweiler Jennifer,
Fu Pingfu,
Cooper Brenda W.,
Meyerson Howard,
Lazarus Hillard M.,
Simic Alexandra,
Laughlin Mary J.,
Gerson Stanton L.,
Koç Omer N.
Publication year - 2006
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.2005.05827.x
Subject(s) - ex vivo , in vivo , medicine , rituximab , lymphoma , cd34 , cd20 , b cell , immunology , stem cell , antibody , biology , genetics , microbiology and biotechnology
Summary We investigated the feasibility, safety and efficacy of two B‐cell purging methods in patients with CD20 + non‐Hodgkin lymphoma (NHL) receiving autologous stsem cell transplantation. Myeloid and immune recoveries between the methods were compared. Twenty‐seven patients were randomised to either in vivo purging with rituximab or ex vivo purging by CD34 + cell selection. Both purging methods were efficient at eliminating B‐cells in infusates. When compared with in vivo purging, ex vivo purging was associated with CD34 + cell loss and delayed median neutrophil (10 d vs. 11 d) and platelet (12·5 d vs. 17 d) count recoveries. Lymphocyte recovery was similar in both groups, but immunoglobulin recovery was delayed after in vivo purging. Late‐infectious complications were few in both arms. At a median follow‐up of 27 months, 2‐year probabilities of event‐free survival (EFS) rates were 81% for in vivo purging and 76% for ex vivo purging ( P = 0·66). When compared with 53 unpurged patients, all 27 purged patients had improved 3‐year probabilities of overall survival (89% vs. 70%, P = 0·014) and a trend for improved EFS (78% vs. 57%, P = 0·075). In conclusion, although both purging methods were feasible and safe, rituximab purging was superior as it did not impair CD34 + cell mobilisation and was associated with faster myeloid recovery. Further studies are needed to determine whether rituximab purging is more effective than the use of unpurged autografts.