美罗华联合CHOP方案化疗引起的迟发性中性粒细胞减少

目的：探讨美罗华联合CHOP（R-CHOP）方案化疗的B细胞淋巴瘤患者迟发性中性粒细胞减少（LON）的发生情况及相关危险因素。方法：回顾性分析我科48例应用R-CHOP方案化疗获得完全缓解（CR）的患者临床资料,对其LON的发生情况进行分析。结果：截至末次随访日,13例（27.1%）患者出现了LON,其中10例（20.8%）为III度和IV度,达到中性粒细胞计数（ANC）最低点的中位时间为118天（37-165天）。除1例患者外,余12例发生LON的患者ANC均恢复正常,恢复正常的中位时间为56天（5-212天）,无致命性感染发生。Fisher精确检验结果显示复发难治患者经过CHOP方案化疗后再次应用R-CHOP方案化疗或美罗华疗程数大于4是发生LON的危险因素。结论：R-CHOP方案化疗效果显著,虽可引起LON,但其发生率低,且具有自限性,无致命性不良反应发生,可进一步扩大其在临床上的应用。     

Late-onset neutropenia associated with rituximab therapy: evidence for a maturation arrest at the (pro)myelocyte stage of granulopoiesis

Late-onset neutropenia, i.e. an absolute neutrophil count of <1.5 × 10⁹/l, may follow 4 weeks or more after therapy with rituximab for lymphoma. However, incidence, predisposing factors, and pathogenic mechanisms are still poorly defined. In a retrospective study of 113 consecutive lymphoma patients treated with rituximab, with or without chemotherapy, we found eight patients (7%) with late-onset neutropenia (LON). Median time to onset was 88 days (range, 1–9 months) after last rituximab dose. Median duration of LON was 54 days (range, 1–17 weeks). Four of the eight patients underwent stem cell transplantation. Three patients developed febrile neutropenia and two required treatment with granulocyte colony-stimulating factor. In four subsequently identified patients with severe LON, a maturation arrest at the (pro)myelocyte stage was observed in the bone marrow, similar to that found in severe congenital neutropenia or Kostmann disease. However, none carried mutations in HAX1, thus ruling out such mutations in the development of the maturation arrest in these patients. Nevertheless, our data suggest that rituximab-related LON and congenital neutropenia might share similar neutropenia-causing mechanisms resulting in maturation arrest.     

A high incidence of late-onset neutropenia following rituximab-containing chemotherapy as a primary treatment of CD20-positive B-cell lymphoma: a single-institution study.

BACKGROUND: Late-onset neutropenia (LON) has been reported following rituximab-containing chemotherapy. Its incidence and risk factors, however, have not been extensively studied. PATIENTS AND METHODS: We retrospectively reviewed the medical records of 107 patients treated with rituximab-containing chemotherapy as a primary treatment of CD20-positive B-cell lymphomas and identified cases with LON as defined by the neutrophil count of 相似文献   

Description of late onset neutropenia in indolent lymphoma patients treated with bendamustine plus rituximab

Bendamustine (B) associated with rituximab (R) is widely described in literature for the management of patients with chronic lymphoid leukaemia (CLL) and indolent non‐Hodgkin lymphoma. Safety data regarding late hematotoxicity such as late onset neutropenia (LON) are scarce. The aim of our study was to assess the incidence and to identify risk factors for LON in patients with indolent non‐Hodgkin lymphoma and CLL treated with B and R (B‐R). One hundred forty five patients were treated with B‐R as first or second line. Patients with neutropenia prior induction treatment, treated beyond second line and relapsing within 3 months after the end of induction treatment, were excluded. Patients receiving at least 1 cycle of B‐R and having LON during follow‐up period were included and considered as eligible for toxicity assessment. A complete blood count was performed 4 weeks after the last cycle of induction treatment and thereafter every 3 months for 1 year. Thirty six patients were identified in our cohort (incidence of 25%), mostly affected by CLL (n = 11) and follicular lymphoma (FL) (n = 15). During follow‐up, 84 events of LON were recorded, 61% and 39% were of grades 1/2 and 3/4, respectively. No episode of febrile neutropenia was documented. Amongst 13 of the 15 patients with FL undergoing R maintenance, 8 had treatment discontinuation because of LON. Median time for LON (grade > 2) and time to recovery (grade < 3) were of 11.2 and 17.3 weeks, respectively. One year after B‐R induction, LON persisted in 4 patients. The risk of LON was increased both in patients with FL or CLL and performance status >1. The LON in B‐R treated patients is clinically relevant. Close clinical and biological follow‐up and treatment prophylaxis (eg, valaciclovir and cotrimoxazole) especially for FL patients undergoing maintenance with R monotherapy seems relevant.     

Interstitial pneumonia after autologous hematopoietic stem cell transplantation in B-cell non-hodgkin lymphoma

IntroductionDuring the past decade, interstitial pneumonia (IP) is one of the newly recognized adverse events regarding rituximab therapy. However, disease characteristics of IP after autologous hematopoietic stem cell transplantation (ASCT) have not been well-described since the introduction of rituximab.Patients and MethodsWe retrospectively analyzed 103 patients with B-cell non-Hodgkin lymphoma undergoing ASCT. A propensity scoring system was applied in our analysis to eliminate potential confounding factors of covariates.ResultsThe total number of patients who developed IP was nine. Five patients developed IP among 57 patients previously treated with rituximab, and four patients developed IP among 46 who were rituximab-naïve. Cumulative incidence of IP was 7.8% at 1 year. Among the patients using rituximab, one patient had IP during the peri-engraftment period (cytomegalovirus infection), three patients had IP between 3 and 12 months (Pneumocystis pneumonia [PCP, n = 1] and unknown cause [n = 2]), and the other one patient had IP 3.3 years after ASCT (unknown cause). Four patients in the rituximab-naïve group developed IP between 3 and 12 months (PCP [n = 1] and unknown cause [n = 3]). All nine patients had symptomatic episodes before IP, three of which died of IP or secondary infections. Patients receiving a total body irradiation conditioning regimen had a higher risk of IP (odds ratio = 3.6, P < .001), whereas the incidence was not affected by rituximab usage (P = .85, Log-rank test).ConclusionThis study shows that the rituximab usage was not identified as a risk factor of IP and that total body irradiation was the only independent risk factor for IP. Close monitoring is encouraged when symptomatic unexplained episodes are identified during follow-up examinations after ASCT.     

晚期胃癌患者XELOX方案化疗后维持治疗的疗效及预后生存分析

目的 探讨晚期胃癌患者奥沙利铂联合卡培他滨(XELOX)方案化疗后维持治疗的疗效及预后生存因素.方法 回顾性分析118例晚期胃癌患者的临床资料,所有患者均采取XELOX方案化疗,并进行维持治疗.分析其短期疗效及不良反应发生情况,并采用Cox回归模型探讨影响患者预后的危险因素.结果 治疗后,临床总有效率为22.88％(27/118),疾病控制率为63.56％(75/118),共有7例(5.93％)患者发生3级不良反应,所有患者在化疗维持治疗期间均未出现4级不良反应及化疗相关性死亡.中位总生存期(OS)为12.59个月(95％CI:5.21～22.32),1年生存率为48.30％,2年生存率为26.27％.单因素分析结果显示:组织学分级、有无肝转移、有无淋巴结转移、近期疗效对晚期胃癌患者的中位OS有影响(P﹤0.05);而年龄、性别、胃癌部位、入院时ECOG评分对晚期胃癌患者的中位OS无影响(P﹥0.05).多元逐步Cox回归分析结果显示:组织学分级低、有淋巴结转移、肿瘤控制率差、有肝转移是影响晚期胃癌患者预后的独立危险因素(P﹤0.05).结论 对于晚期胃癌患者,XELOX方案化疗后的维持治疗是一种有效且不良反应程度相对较轻的治疗方案,且组织学分级低、有淋巴结转移、肿瘤控制率差、有肝转移是影响晚期胃癌患者预后的独立危险因素,临床中应当重视.     

恶性血液病合并带状疱疹的临床分析

目的探讨恶性血液病患者治疗过程中合并带状疱疹的发病情况、危险因素、治疗及预后。方法回顾性分析21例合并带状疱疹的恶性血液病患者的临床资料。结果 741例恶性血液病患者中有21例合并带状疱疹,发生率为2.8%。感染发生部位多位于胸、腰部皮肤。中位发病时间为化疗开始后4.5个月。年龄≥45岁的患者带状疱疹发生率明显高于<45岁患者(3.9%vs 0.8%,P=0.01)。采用含利妥昔单抗化疗方案的患者带状疱疹发生率显著高于不含利妥昔单抗化疗方案的患者(7.0%vs 2.3%,P=0.026)。治疗以静脉滴注阿昔洛韦或阿糖腺苷为主要方案,平均病程为12 d,2例高龄患者同时合并真菌感染死亡,其余患者均治愈。结论恶性血液病患者合并带状疱疹的发生率较正常人群明显增高;年龄≥45岁、应用利妥昔单抗可能是其发生的危险因素;通过有效抗病毒治疗,可使大部分患者获得痊愈;对于免疫力异常低下患者,合并带状疱疹提示预后不良。     

Thromboembolic events with lenalidomide-based therapy for multiple myeloma

BACKGROUND: The purpose was to evaluate the incidence and risk factors of thromboembolism associated with lenalidomide therapy in newly diagnosed myeloma. METHODS: A pooled analysis was performed of patients with previously untreated multiple myeloma enrolled in clinical trials of lenalidomide-based therapy at the Mayo Clinic, Rochester, Minnesota, and the Italian Myeloma Network, Italy. The incidence of thrombosis, the effect of risk factors such as steroid dose and erythropoietin supplementation, and the effect of prophylaxis were examined. RESULTS: In all, 125 patients enrolled in 3 clinical trials were identified. Patients were stratified based on the concomitant corticosteroid dose. Fifty-two patients were in the high-dose group (dexamethasone 40 mg, 12 days a month); 73 patients were in the low-dose group (prednisone at any dose; or dexamethasone 40 mg, 4 days a month). A total of 110 patients were initiated on thromboprophylaxis; of these, 104 patients (95%) received aspirin. Ten patients (8%) developed deep vein thrombosis, including 4 who were not receiving any thromboprophylaxis at the time of the event. The rate of thromboembolic events was not different between patients who received concomitant erythropoietin therapy and those who did not, 4.8% and 8.6%, respectively (P= .54). A higher number of venous thrombotic episodes occurred in the high-dose corticosteroid group compared with the low-dose corticosteroid therapy group (12% vs 6%), but the difference was not statistically significant (P= .3). CONCLUSIONS: The incidence of deep vein thrombosis is lower than previously reported in the literature. There was a trend to a higher incidence of thrombosis in patients receiving high-dose corticosteroid therapy.     

恶性肿瘤患者免疫治疗相关肝不良事件的影响因素

目的探讨恶性肿瘤患者免疫治疗相关肝毒性的临床特征及其影响因素。方法回顾性分析2016年1月至2019年3月就诊于中国医学科学院肿瘤医院深圳医院南山肿瘤中心和华中科技大学协和深圳医院接受免疫检查点抑制剂治疗的112例恶性肿瘤患者的临床资料,其中男64例,女48例;中位年龄60岁。结果112例患者中,肝不良事件发生率为26.8%(30/112),3~5级肝不良事件发生率为7.14%(8/112),出现肝不良事件的中位时间为接受免疫治疗后3周。单因素及多因素分析均显示,患者肝不良事件的发生与肝癌有关(P<0.05)。发生3~5级肝不良事件患者接受规范甲强龙治疗后,4~6周内肝功能恢复。结论肝癌为恶性肿瘤患者免疫治疗发生相关肝脏不良事件的危险因素。     

抗PD-1抗体联合治疗晚期肝细胞癌的真实世界研究

目的探讨真实世界中以抗PD-1抗体为基础的疗法在晚期肝细胞癌治疗中的疗效、不良反应及可能影响疗效的因素。方法收集55例接受以PD-1抗体为基础治疗的晚期肝细胞癌患者,回顾性分析其临床特点、疗效及不良反应,并进行随访。结果客观有效率为21.8%,疾病控制率为76.4%。治疗过程中不良反应整体发生率为81.8%,其中3~4级不良反应发生率为14.5%,免疫相关不良反应发生率为58.2%,其中3~4级免疫相关不良反应发生率为3.6%,无治疗相关死亡。55例患者中位无进展生存期为5.0月(95%CI:3.9~6.1),中位生存期11.4月(95%CI:6.5~16.3)。应用抗PD-1抗体前患者肝功能Child-Pugh评分和体能状态ECOG评分是影响治疗有效率和生存时间的主要因素;多因素分析也表明治疗前患者的体能状态ECOG评分和肝功能Child-Pugh评分是影响患者生存的独立预后因素(P<0.001,P=0.034)。结论真实世界中以PD-1抗体为基础的治疗在晚期肝细胞肝癌患者中是安全有效的,其中治疗前患者的体能状态ECOG评分和肝功能Child-Pugh评分是影响患者生存期的独立预后因素。     

非霍奇金淋巴瘤患者利妥昔单抗化疗后肺部并发症的特点及对生存率的影响

目的:探讨非霍奇金淋巴瘤（non-Hodgkin' s lymphoma,NHL）患者接受利妥昔单抗化疗后肺部并发症的发生率、发病特点及对生存率的影响。方法:收集2011年1月至2016年6月在我院接受含利妥昔单抗方案化疗的163例NHL患者作为研究对象,观察患者肺部并发症的发生率、发病特点,采用单因素与多因素分析观察肺部并发症与患者3年死亡率的相关性。结果:163例患者中共37例患者发生64例次呼吸系统并发症,并发症发生率为22.70％。肺部并发症和无肺部并发症患者性别、年龄、体质量指数、NHL类型、NHL分期、左心室射血分数、利妥昔单抗总剂量相比较差异均无统计学意义（P＞0.05）,肺部并发症患者肺/胸膜受累患者百分率高于无肺部并发症患者,差异有统计学意义（P＜0.05）。患者3年生存率为80.98％。单因素和多因素分析均显示,肺部并发症是影响NHL患者预后的风险因素（P＜0.05）。结论:NHL接受利妥昔单抗化疗后肺部并发症与患者3年死亡风险增加相关。     

Incidence and risk factors for central nervous system occurrence in elderly patients with diffuse large-B-cell lymphoma: influence of rituximab.

BACKGROUND: The incidence of secondary central nervous system (CNS) occurrences in diffuse large-B-cell lymphoma is not sufficiently high to warrant the use of CNS prophylaxis in all patients. The addition of rituximab increases the complete response rate and prolongs event-free and overall survival in elderly patients with such lymphoma. PATIENTS AND METHODS: We analyzed a cohort of 399 elderly patients with lymphoma prospectively treated with eight cycles of CHOP with or without rituximab in order to assess if rituximab decreases the risk of CNS localization. Prophylaxis of CNS disease was not part of the treatment protocol. RESULTS: We observed 20 CNS occurrences: 12 on therapy, four after partial remission and four following complete remission. In three patients, the CNS was the only site of relapse. In a multivariate analysis, increased age-adjusted International Prognostic Index (IPI) was the only independent predictive factor of CNS recurrence. Only three of 20 patients are alive with a follow-up of 24 months. CONCLUSIONS: Rituximab did not influence the risk of CNS occurrence, possibly because of low rituximab diffusion. Direct intrathecal administration of rituximab could overcome this problem. We also confirmed that CNS occurrence is related to IPI as well as very poor prognosis of relapses occurring on therapy.     

The role of maintenance therapy in patients with diffuse large B cell lymphoma: A systematic review and meta‐analysis

Randomized trials of maintenance therapy (MT) in diffuse large B cell lymphoma (DLBCL) are inconclusive regarding its effect on overall survival (OS) and disease control. We aimed to examine the efficacy and safety of MT in this meta‐analysis. Systematic review and meta‐analysis of randomized controlled trials comparing MT with observation or placebo, in patients with DLBCL, who achieved complete response (CR) or partial response (PR) after first‐line chemotherapy with or without rituximab. Primary outcome was OS. Secondary outcomes included relapse rate, disease control (defined as progression‐free survival, event‐free survival, or disease‐free survival, as reported in the original trials), and safety. Our search yielded 14 trials including 5122 patients. Median age of patients was 49 to 70 years. Six trials included rituximab as the MT; three included Interferon alfa; other trials include thalidomide, lenalidomide, cyclophosphamide and prednisone, serine threonine kinase inhibitor enzastaurin, and mTOR inhibitor everolimus. MT did not improve OS compared to observation, OR 0.91, (95% CI 0.78‐1.07). Results were the same in a subgroup analysis by the type of maintenance (rituximab vs other). MT did decreased relapse rate, RR 0.76 (95% CI 0.65‐0.89) and improved disease control, OR 0.74 (95% CI 0.65‐0.84). Disease control was significantly improved in the subgroup of studies evaluating rituximab as maintenance OR 0.61 (95% CI 0.47‐0.79) and in the subgroup of R‐CHOP induction studies OR 0.77 (95% CI 0.67‐0.88). Serious or grade III/IV adverse events including neutropenia and infections were significantly more common in the maintenance arm, RR = 1.69 (95% CI 1.29‐2.22). MT in patients with DLBCL achieving CR or PR after induction therapy did not affect OS, yet it decreased relapse rate and improved disease control at the cost of higher infection rate. Our data do not support routine administration of MT in patients with DLBCL.     

High-dose therapy followed by autologous stem-cell transplantation with and without rituximab for primary treatment of high-risk diffuse large B-cell lymphoma

BackgroundWe aimed to determine safety and efficacy of rituximab (R) in combination with repetitive high-dose therapy (HDT) as primary treatment for diffuse large B-cell lymphoma (DLBCL).Patients and methodsPatients aged 18–60 years and elevated lactate dehydrogenase were treated with four cycles of MegaCHOEP and transplantation of autologous stem cells after cycles 2, 3 and 4. Rituximab (375 mg/m²) was given before each cycle and 12 and 33 days after start of the last cycle of chemotherapy. Sixty-four patients given R-MegaCHOEP were compared with 29 patients who had received identical treatment without rituximab.ResultsOverall survival (OS) and event-free survival (EFS) after 3 years were significantly improved in patients treated with R-MegaCHOEP (OS: 78.7% versus 55.0%, P = 0.045; EFS: 72.7% versus 47.2%, P = 0.013). In a Cox regression model adjusted for performance status and stage, relative risk of treatment failure was lower (relative risk 0.5, P = 0.041) and OS was better (relative risk 0.4, P = 0.054) for patients given R-MegaCHOEP. Grade 3/4 infections were more frequent in the R-MegaCHOEP group (18.5% versus 6.0%, P = 0.003).ConclusionsThe addition of rituximab to MegaCHOEP significantly improved outcome in young patients with high-risk DLBCL. The higher incidence of grade 3/4 infections needs consideration when rituximab and HDT regimens are combined.     

Multicentre phase II study of CyclOBEAP plus rituximab in patients with diffuse large B‐cell lymphoma

The R‐CHOP regimen has been found to improve the outcome of diffuse large B‐cell lymphoma (DLBCL). However, it does not provide a satisfactory treatment outcome in the high‐risk group. We previously administered the CyclOBEAP regimen to patients with DLBCL, and reported its safety and efficacy. The R‐CyclOBEAP regimen was administered over a total period of 12 weeks, and rituximab 375 mg/m² was given every 2 weeks. There were 101 eligible patients. CR was achieved in 96 patients (95%). The 5‐year overall survival (OS) rate was 85% and progression‐free survival (PFS) rate was 76%. When the patients were divided according to the IPI, the 5‐year OS and PFS rates did not significantly differ among the risk groups. The 5‐year PFS of the germinal centre B‐cell group was 80% and that of the non‐GCB group was 74% (NS). Univariate analysis showed that the presence of B symptoms, extranodal lesions ≧2, and sIL‐2R were significant poor prognostic factors. Grade 4 neutropenia was observed in 91 patients and thrombocytopenia in 9 patients. The addition of rituximab to CyclOBEAP therapy may enhance the effect of CyclOBEAP therapy for DLBCL. Copyright © 2010 John Wiley & Sons, Ltd.     

omega-3 Fatty acid-containing diet (Racol) reduces toxicity of chemoradiation therapy for patients with esophageal cancer

Recently, it is reported that a omega-3 fatty acid-containing diet (Racol) enhances innate immunity and reduces mucosal damage in the small intestine during chemotherapy. The aim of this study is to examine the effects of a omega-3 fatty acid-containing diet (Racol) on the toxicity of chemoradiation therapy (CRT) for patients with esophageal cancers. Toxicity of CRT was evaluated in 10 patients who took Rakol at a maximum dose of 600 mL/day during CRT, compared with 10 patients who did not take Rakol. Regarding blood toxicity, the decrease of platelets did not differ between the former and the latter. However, the incidence of grade 2~4 neutropenia was lower in the former than in the latter (p=0.0043). With regard to gastrointestinal toxicity, the incidence of grade 2~4 diarrhea was also lower in the former than in the latter (p=0.0118). Moreover, the incidence of grade 2~4 stomatitis/pharyngitis tended to decrease in patients who took Rakol compared with those who did not (p=0.0812). The current results indicated that a omega-3 fatty acid-containing diet (Racol) may be beneficial to patients with esophageal cancers who receive CRT by reducing CRT toxicity.     

Early administration of pegfilgrastim for esophageal cancer treated with docetaxel,cisplatin, and fluorouracil: A phase II study

Preoperative or induction chemotherapy with docetaxel, cisplatin, plus 5‐fluorouracil (DCF) is a promising regimen for advanced esophageal cancer. However, the DCF regimen is associated with a high risk of severe neutropenia or febrile neutropenia (FN). However, the current guidelines fail to recommend an optimal dosing schedule of pegfilgrastim along with the DCF regimen to prevent FN. In the present study, we assessed the efficacy and safety of giving pegfilgrastim early on day 3 during DCF therapy for esophageal cancer. In this single‐arm phase II study, patients with squamous cell carcinoma of the esophagus were recruited. They were treated with the DCF therapy on days 1‐5, with pegfilgrastim given on day 3. Primary endpoint was the occurrence of grade 4 neutropenia. Secondary endpoints included the incidence of FN, grade 3 neutropenia, dose delays/reductions, antitumor effect, and safety. Between July 2016 and December 2018, 23 patients were enrolled. The incidence of grade 4 neutropenia was 8.7% (95% confidence interval 1.1%‐28.0%). No patient experienced FN. Of the 19 patients who received two cycles of DCF, one required a dose reduction/treatment delay due to hematological toxicity in the second treatment cycle. No serious adverse events, considered relevant to pegfilgrastim, were observed. This is the first prospective study that showed an efficacious dosing schedule of pegfilgrastim for preventing hematological toxicity during DCF therapy. The results might be generalized to other similar regimens where continuous infusions of 5‐fluorouracil are used.     

Impact of Split Dosing the First Rituximab Infusion in Patients with High Lymphocyte Count

The most common adverse reactions to rituximab are infusion-related reactions (IRR). We evaluated the efficacy of split dosing the first rituximab infusion over two days to reduce IRR incidence in patients with hematological cancer and a high lymphocyte count. This is a retrospective observational study conducted in two healthcare centers in Quebec, Canada. The study enrolled patients with white blood cell counts ≥25.0 × 10⁹/L who received their first rituximab dose for hematological cancer between December 2007 and May 2020. One healthcare center used asymmetrical split dosing, while the other used symmetrical split dosing. A total of 183 treatment episodes were collected from 143 patients. Among patients who received a fractionated dosing schedule, 42% developed an IRR from the first rituximab infusion compared with 50% for the standard protocol (adjusted relative risk, 0.89; p = 0.540). No significant difference was observed in IRR severity between either groups. However, 24% of patients who received the asymmetrical protocol developed an IRR compared to 68% for the symmetrical protocol (adjusted relative risk, 0.32; p = 0.003). These results suggest that an asymmetrical split dosing could be effective in reducing the incidence of IRR and is preferable to a symmetrical one.     

Prognostic factors for non-Hodgkin's lymphoma patients treated with chemotherapy may not predict outcome in patients treated with rituximab

Several factors predict outcome for patients with non-Hodgkin's lymphoma (NHL) after chemotherapy. However, predictors of response to rituximab have not been identified. Baseline characteristics for 166 NHL patients (130 follicular) in a phase III trial of rituximab were analysed by univariate and multivariate methods to determine whether any of 27 factors predict response and/or response duration. In a univariate analysis, response to rituximab was associated with follicular histology, no prior fludarabine therapy, prior autologous bone marrow transplantation (ABMT), lack of bone marrow involvement or extranodal disease, positive bcl-2 in blood, and fewer relapses. By univariate analysis, longer median time to progression (TTP) and/or duration of response (DR) after rituximab therapy was associated with International Prognostic Index lower-risk group, multiagent chemotherapy, and low/normal serum lactate dehydrogenase (LDH) or beta2 microglobulin. In the multivariate analysis, response to rituximab correlated with follicular histology, prior ABMT, multiagent chemotherapy, and no bone marrow involvement; longer TTP and/or DR correlated with low/normal serum LDH or beta2 microglobulin, high CD3+ cells, and response to last chemotherapy. The follicular lymphoma international prognostic index (FLIPI) did not correlate consistently with response to rituximab or response duration. Several factors associated with prognosis following chemotherapy did not correlate with response to rituximab or response duration. NHL patients can respond to rituximab despite having factors associated with a poor outcome to chemotherapy.