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  • Letter to the Editor
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Rituximab in CD20 positive multiple myeloma

Leukemia volume 22, pages 1082–1083 (2008)Cite this article

In the letter of Moreau,1 the result of a small trial of the treatment with rituximab as a single agent in patients with multiple myeloma (MM) that expresses CD20 is reported. In this trial, there is no benefit for the patients newly diagnosed or relapsed with CD20+ MM. In a later letter of Gozzetti,2 complete remission is reported in a single patient with CD20+ MM refractory to high dose melphalan. This patient was treated with four courses of weekly rituximab addressing the possibility that a timing effect of rituximab could explain its activity. Notwithstanding these reports, no results of the combination treatment of chemotherapy plus rituximab in CD20+ MM have been published.

The activity of rituximab in unselected patients with MM was supposedly based on the presence of clonotypic B-cell precursor plasma cells that express CD20.3 This hypothesis, disappointingly, was not confirmed in small trials.4, 5 In the work of Moreau, using selected CD20+ MM patients, rituximab as single agent was not effective. In our patient, relapse had the characteristics of the final phase of MM: massive bone marrow infiltration; clinical aggressiveness; plasmablastic morphology; change in immunophenotype and refractory disease to the combination of bortezomib and dexamethasone corroborate this point of view. The use in this case of rituximab plus VAD was impressive in the first cycle. We think that the use of rituximab in combination with some type of concurrent chemotherapy like VAD, merits further trials in patients with positive CD20+ MM, and as in the case of B-lymphoma, synergism might be found. Unfortunately the scarcity of patients with CD20+ MM who can be enrolled in a trial limits the capacity of unraveling the more effective association and drug schedule.

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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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Authors and Affiliations

  1. Servicio de Hematología, Hospital San Pedro de Alcántara, Avda. Pablo Naranjo s/n, Cáceres, Spain

    J M Bergua, C Cabrera, E G Arteta & J Prieto

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  1. J M Bergua
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  2. C Cabrera
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  3. E G Arteta
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  4. J Prieto
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Correspondence to J M Bergua.

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Bergua, J., Cabrera, C., Arteta, E. et al. Rituximab in CD20 positive multiple myeloma. Leukemia 22, 1082–1083 (2008). https://doi.org/10.1038/sj.leu.2405010

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