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Chronic Lymphocytic Leukemia

A phase I/II study of rituximab and etanercept in patients with chronic lymphocytic leukemia and small lymphocytic lymphoma

Leukemia volume 23, pages 912–918 (2009)Cite this article

Abstract

Rituximab has modest activity in relapsed chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma but is associated with tumor necrosis factor-α (TNF-α) release that can cause CLL proliferation and inhibit apoptosis. We examined whether disruption of TNF-α by etanercept improves response to rituximab in CLL. Eligible patients had previously treated CLL with performance status 0–3. Patients received etanercept 25 mg subcutaneously twice weekly (weeks 1–5) and rituximab 375 mg/m2 intravenously thrice weekly (weeks 2–5) using a phase I/II design. Primary end points were response and toxicity. The 36 enrolled patients had a median of two prior treatments; 50% were fludarabine refractory and 22% had del(17p13.1). Of the 34 response-evaluable patients, 10 (29%) responded, including 9 partial responses and 1 complete remission. Response was not affected by prior rituximab or fludarabine-refractory status, but no patients with del(17p13.1) responded. Median progression-free survival for responders was 9.0 months (range 1–43). Ten patients have had treatment-free intervals exceeding 12 months, including four who have remained untreated for 32, 43, 46 and 56 months. Adverse events were mild, including mild infusion reactions, transient cytopenias and grade 3 infections in 14% of the patients. The combination of etanercept and thrice weekly rituximab produces durable remissions in non-del(17p13.1) CLL patients and is well tolerated.

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Acknowledgements

This work was supported by National Cancer Institute P01 CA9542, The Leukemia and Lymphoma Society and The D Warren Brown Foundation.

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  1. J A Woyach and T S Lin: Both the authors contributed equally to this work.

Authors and Affiliations

  1. Department of Internal Medicine, The Ohio State University, Columbus, OH, USA

    J A Woyach, T S Lin, M S Lucas, M E Moran, C Cheney, D M Lucas, M A Caligiuri & J C Byrd

  2. Department of Pathology, The Ohio State University, Columbus, OH, USA

    N Heerema

  3. Center for Biostatistics, The Ohio State University, Columbus, OH, USA

    L Wei

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Woyach, J., Lin, T., Lucas, M. et al. A phase I/II study of rituximab and etanercept in patients with chronic lymphocytic leukemia and small lymphocytic lymphoma. Leukemia 23, 912–918 (2009). https://doi.org/10.1038/leu.2008.385

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