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Reply to Gozzetti et al.

Leukemia volume 22, pages 1083–1084 (2008)Cite this article

Gozzetti et al.1 agree with us on the possible superiority of rituximab associated with chemotherapy in selected CD20-positive multiple myeloma (CD20+MM) patients. It must be stressed that this type of association has never been explored in any trial or single patient experience and the use of rituximab as a single agent was ineffective in CD20+MM.2, 3

As Gozzetti points out, rituximab was used to achieve the best remission post-autologous stem cell transplantation.4 Nevertheless, the use of rituximab post-stem cell therapy in patients with unselected MM has been associated with IgM deficiency increase the risk of infection and no published long-term outcome of this type or therapy.5 We think that perhaps rituximab plus VAD (R-VAD) might be used previously to high-dose therapy in order to reduce tumour burden (optimal timing, as Gozzetti et al. report, is important). Noteworthy, in our patient R-VAD therapy was impressive; considering the lack of previous response to bortezomib–dexametasone salvage treatment. Nowadays, our patient is in complete remission seven months after stem cell transplantation and nine after the fourth R-VAD cycle.

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References

  1. Gozzetti A, Fabbri A, Lazzi S, Bocchia M, Lauria F . Reply to ‘Rituximab activity in CD20 positive multiple myeloma’ by Bergua et al. Leukemia 2008; e-pub ahead of print 1 November 2007.

  2. Zojer N, Kirchbacher K, Vesely M, Hubl W, Ludwig H . Rituximab treatment provides no clinical benefit in patients with pretreated advanced multiple myeloma. Leuk Lymphoma 2006; 47: 1103–1109.

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  3. 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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  4. Gozzetti A, Fabbri A, Lazzi S, Bocchia M, Lauria F . Reply to Rituximab activity in CD20 positive multiple myeloma. Leukemia 2007; 21: 1842–1843.

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  5. Lim SH, Zhang Y, Wang Z, Varadarajan R, Periman P, Esler WV . Rituximab administration following autologous stem cell transplantation for multiple myeloma is associated with severe IgM deficiency. Blood 2004; 103: 1971–1972.

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Authors and Affiliations

  1. Servicio de Hematología, Hospital San Pedro de Alcántar, Cáceres, Spain. E-mail: jmbergua@terra.es,

    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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Bergua, J., Cabrera, C., Arteta, E. et al. Reply to Gozzetti et al.. Leukemia 22, 1083–1084 (2008). https://doi.org/10.1038/sj.leu.2405012

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