ASH 2015

Response to rituximab induction is a predictive biomarker in post-transplant lymphoproliferative disorder

Prof Corrado Tarella - Istituto Europeo di Oncologia, Milano, Italy

In the context of post-transplant lymphoproliferative disorder you’ve been conducting a study looking at rituximab response, so you give patients rituximab, see how they respond, and that has an implication. Why were you interested in that and what were you doing?

Well I’m interested in what you said, post-transplant lymphoproliferative. These are the lymphomas that arise in 3-5% of cases following solid organ transplant and is due to the immunosuppression that these patients need to receive. So they have the risk of developing a sort of lymphoma; it’s a particular type of lymphoma. So we made a multicentre European study and I participated with this study. It’s a German guy who is co-ordinating this study, a friend of mine, Ralf Trappe, and absolutely we obtained very important results in this setting because once this situation was very difficult, a measured problem in this solid organ transplant.

Right, so you would use rituximab as a treatment and then monitor how well the patients do with rituximab, what then?

Yes. Those patients who are responding to rituximab, now we know they do well, they do not deserve too much chemotherapy. Otherwise patients who are not responding to rituximab may undergo chemotherapy and they have usually a very good outcome.

How reliable is using that particular biomarker as an indication for stratifying your treatment?

Yes, it’s a very general approach because I have another presentation here at ASH, not in the post-transplant setting, in the normal, in the so-called novel lymphoma, the follicular lymphoma. We saw that unfortunately a proportion, a small proportion, of these patients do not respond at the initial treatment but those who are good responders they do extremely well and in this particular type of patient, which is the follicular lymphoma, those who are responding to the initial treatment, which is the majority of the patients, they do have 32 years of survival which is quite similar to the normal population. So I think that for all our patients we have to continue in evaluating the initial response and the initial response may drive our subsequent management of our patients. We can decide whether to intensify the treatment or de-escalate the treatment.

So what is the brief, clinical message for doctors coming out of this work?

For both work, for both the PTLD study and for the other study in follicular lymphoma, first measure that these patients if they are correctly managed if they receive the rituximab combined with the chemotherapy they have definitely improved the outcome compared to a few years ago. Most of these patients may experience a prolonged survival.