Cancer Research and Treatment

Original Articles

A Phase II Study of Bendamustine Plus Rituximab in Patients with Relapsed or Progressive Marginal Zone Lymphoma: KCSG LY14-09: Jeong-Ok Lee, Jinny Park, Hye Jin Kang, Shin Young Hyun, Gyeong-Won Lee, Ho-Young Yhim, Hyo Jung Kim, Jong Seok Lee, Dae Seog Heo, Tae Min Kim; Received August 1, 2025 Accepted December 2, 2025 Published online December 3, 2025; DOI: https://doi.org/10.4143/crt.2025.815 [Accepted]

Abstract PDF: Purpose
This multicenter, phase II study examined the efficacy and safety of bendamustine plus rituximab in patients with relapsed or progressive marginal zone lymphoma (MZL).
Materials and Methods
Patients received six cycles of bendamustine 90 mg/m² intravenously on days 2 and 3, rituximab 375 mg/m² intravenously in cycle 1, and 1,400 mg subcutaneously in cycles 2–8 on day 1 every 4 weeks. Bendamustine dose reduction to 60 mg/m² (level -1) and 40 mg/m² (level -2) was allowed based on prespecified toxicity criteria. The primary endpoint was overall response rate (ORR) and the secondary endpoints included progression-free survival (PFS), overall survival (OS), and safety.
Results
Among the 26 evaluable patients, 81.8% achieved an ORR, while 40.7% had a complete response. The median PFS was 46.06 months, and the estimated 3-year OS rate was 92.3%. Hematological toxicities, primarily neutropenia (grade 3/4, 48.1%), were the most common adverse events, resulting in both reduction and interruption of bendamustine doses, accounting for 18 (75%) of 24 dose-reduced cycles and 7 (41%) of 17 missed cycles, respectively. Nonhematologic toxicities were generally mild, with nausea and fatigue identified as the most frequently reported toxicities. The mean relative dose intensities were 76.9% (range, 31.5–100) for bendamustine and 91.3% (range, 72.7–100) for rituximab.
Conclusion
Bendamustine plus rituximab is a highly effective and tolerable treatment for patients with relapsed or progressive MZL, providing durable disease control.

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Chemotherapy-Free Salvage Therapy with Rituximab, Lenalidomide, and Poseltinib in Relapsed or Refractory Primary Central Nervous System Lymphoma: A Multi-Center, Phase II Study: Dong Hyun Kim, Sanyeowool An, Hongyul Ahn, Han Song, Ka-Won Kang, Sang Eun Yoon, Seok Jin Kim, Hyo Jung Kim, Youngil Koh, Deok-Hwan Yang, Consortium for Improving Survival of Lymphoma (CISL); Received September 6, 2025 Accepted November 11, 2025 Published online November 12, 2025; DOI: https://doi.org/10.4143/crt.2025.977 [Accepted]

Abstract PDF: Purpose
Relapsed or refractory (R/R) primary central nervous system lymphoma (PCNSL) is an aggressive malignancy for which salvage chemotherapy has limited efficacy. We conducted an investigator-initiated, single-arm, multicenter phase II trial to evaluate the efficacy and safety of a chemotherapy-free salvage regimen comprising rituximab, lenalidomide, and poseltinib (R2P) in patients with R/R PCNSL.
Materials and Methods
The R2P regimen consisted of two phases: six cycles of induction with rituximab, lenalidomide, and poseltinib, followed by three cycles of consolidation with lenalidomide and poseltinib. The primary endpoints were complete response rate (CRR) and overall response rate (ORR). Secondary endpoints were toxicity, progression-free survival (PFS) and overall survival (OS).
Results
A total of 10 patients were enrolled (one withdrew before cycle 1; nine were evaluable for efficacy). The median age was 70 years (range, 53–75), and all had received methotrexate-based first-line chemotherapy. The ORR was 55.6%, and the CRR was 33.3%. The median PFS was 5.6 months, and the median OS was not reached. Next-generation sequencing was performed in four patients (three responders and one non-responder). CD79B missense mutations were identified in all three responders. A total of 11 adverse events (AEs) were observed in six patients. The most common AE was neutropenia (30.0%). The only grade ≥3 AE was a single case of grade 3 neutropenia. No dose modifications were required due to toxicity.
Conclusion
Poseltinib in combination with lenalidomide and rituximab showed activity in patients with R/R PCNSL, warranting further investigation in larger studies.

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Hematologic malignancy

Impact of T-Cell Engagers on COVID-19–Related Mortality in B-Cell Lymphoma Patients Receiving B-Cell Depleting Therapy: Chan Mi Lee, Pyoeng Gyun Choe, Chang Kyung Kang, Hyeon Jae Jo, Nam Joong Kim, Sung-Soo Yoon, Tae Min Kim, Wan Beom Park, Myoung-don Oh; Cancer Res Treat. 2024;56(1):324-333. Published online July 6, 2023; DOI: https://doi.org/10.4143/crt.2023.738

Abstract PDF Supplementary Material PubReader ePub

Purpose
B-cell depleting therapies, including T-cell engager (TCE), are increasingly used for patients with hematologic malignancies, including during the coronavirus disease 2019 (COVID-19) pandemic. We aimed to evaluate the relationship between TCE therapy and COVID-19–related outcomes among patients with COVID-19 and B-cell lymphomas receiving B-cell depleting therapy.
Materials and Methods
This retrospective cohort study included patients with B-cell lymphoma, who were admitted to Seoul Natio-nal University Hospital with COVID-19 between September 2021 and February 2023, and received B-cell depleting therapy before COVID-19 diagnosis. Multivariable logistic regression was used to identify factors associated with severe to critical COVID-19 and COVID-19–related mortality.
Results
Of 54 patients with B-cell lymphomas and COVID-19 who received B-cell depleting therapy, 14 were treated with TCE (TCE group) and 40 with rituximab (RTX group). COVID-19–related mortality was higher in the TCE group than in the RTX group (57.1% vs. 12.5%, p=0.002). In multivariable analyses, TCE therapy (adjusted odds ratio [aOR], 7.08; 95% confidence interval [CI], 1.29 to 38.76; p=0.024) and older age (aOR, 1.06; 95% CI, 1.00 to 1.13; p=0.035) were associated with severe to critical COVID-19. TCE therapy (aOR, 8.98; 95% CI, 1.48 to 54.40; p=0.017), older age (aOR, 1.13; 95% CI, 1.02 to 1.26; p=0.022), and prior bendamustine therapy (aOR, 7.78; 95% CI, 1.17 to 51.65; p=0.034) were independent risk factors for COVID-19–related mortality.
Conclusion
B-cell lymphoma patients treated with TCE had significantly worse outcomes from COVID-19 than those treated with RTX. TCE therapy should be used with caution in B-cell lymphoma patients during the COVID-19 epidemic.

Citations

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Severe COVID-19 in the Republic of Korea: Epidemiology, Risk Factors, Therapeutics, and Prognostic Models From Nationwide Data
Jun Yong Choi
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Epcoritamab plus GemOx in transplant-ineligible relapsed/refractory DLBCL: results from the EPCORE NHL-2 trial
Joshua D. Brody, Judit Jørgensen, David Belada, Régis Costello, Marek Trněný, Umberto Vitolo, David John Lewis, Yasmin H. Karimi, Anna Sureda, Marc André, Björn E. Wahlin, Pieternella J. Lugtenburg, Tony Jiang, Kubra Karagoz, Andrew J. Steele, Aqeel Abbas
Blood.2025; 145(15): 1621. CrossRef
Impact of SARS-CoV-2 infection on bispecific antibody treatment in patients with B-cell lymphoproliferative disorders
Ángel Serna, Víctor Navarro, Moraima Jiménez, Josu Iraola-Truchuelo, Marc Bosch, Cristina García, Anna Falcó, Adaia Albasanz, Isabel Ruiz-Camps, Cristina Andrés, Andrés Antón, Juliana Esperalba, Ainara Ferrero, Tomás García, Cecilia Carpio, Marta Crespo,
Blood Advances.2025; 9(16): 4180. CrossRef
Fragment-Based Immune Cell Engager Antibodies in Treatment of Cancer, Infectious and Autoimmune Diseases: Lessons and Insights from Clinical and Translational Studies
Ge Yang, Mohammad Massumi
Antibodies.2025; 14(3): 52. CrossRef
T-cell engaging antibodies for B-cell lymphomas
Dong Hyun Kim, Tae Min Kim
Seminars in Hematology.2025; 62(4): 255. CrossRef
Long-Term Outcomes of COVID-19 and Risk Factors for Prolonged or Persistent COVID-19 in Lymphoma Patients: A Multicenter, Retrospective Cohort Study
Jung Ah Lee, Min Han, Sangmin Ahn, Yongseop Lee, Joon-Sup Yeom, Jun Yong Choi, Nam Su Ku, Su Jin Jeong, Jung Ho Kim, Jin Seok Kim, Haerim Chung, Hyunsoo Cho, Yu Ri Kim, Jin Young Ahn
Journal of Korean Medical Science.2024;[Epub] CrossRef
Features of the T-cell immune response in patients with hematological diseases after SARS-CoV-2 infection and vaccination
K. V. Zornikova, N. O. Ivanova, O. A. Aleshina, S. A. Sheetikov, V. D. Davydova, A. V. Bogolyubova
Russian journal of hematology and transfusiology.2024; 69(2): 200. CrossRef
Call for Balancing the Risks and Benefits of Immunotherapeutic Agents for Lymphoma during the COVID-19 Pandemic
Chan Mi Lee, Wan Beom Park
Infection & Chemotherapy.2024; 56(3): 406. CrossRef
Epcoritamab in relapsed/refractory large B-cell lymphoma: 2-year follow-up from the pivotal EPCORE NHL-1 trial
Catherine Thieblemont, Yasmin H. Karimi, Herve Ghesquieres, Chan Y. Cheah, Michael Roost Clausen, David Cunningham, Wojciech Jurczak, Young Rok Do, Robin Gasiorowski, David John Lewis, Tae Min Kim, Marjolein van der Poel, Michelle Limei Poon, Tatyana Feld
Leukemia.2024; 38(12): 2653. CrossRef

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Intensified First Cycle of Rituximab Plus Eight Cycles of Cyclophosphamide, Doxorubicin, Vincristine, and Prednisolone with Rituximab Chemotherapy for Advanced-Stage or Bulky Diffuse Large B-Cell Lymphoma: A Multicenter Phase II Consortium for Improving Survival of Lymphoma (CISL) Study: Yu Ri Kim, Jin Seok Kim, Won Seog Kim, Hyeon Seok Eom, Deok-Hwan Yang, Sung Hwa Bae, Hyo Jung Kim, Jae Hoon Lee, Suk-Joong Oh, Sung-Soo Yoon, Jae-Yong Kwak, Chul Won Choi, Min Kyoung Kim, Sung Young Oh, Hye Jin Kang, Seung Hyun Nam, Hyeok Shim, Joon Seong Park, Yeung-Chul Mun, Cheolwon Suh, the Korean Society of Hematology Lymphoma Working Party; Cancer Res Treat. 2023;55(4):1355-1362. Published online March 30, 2023; DOI: https://doi.org/10.4143/crt.2023.271

Abstract PDF Supplementary Material PubReader ePub

Purpose
This phase II, open-label, multicenter study aimed to investigate the efficacy and safety of a rituximab intensification for the 1st cycle with every 21-day of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP-21) among patients with previously untreated advanced-stage or bulky diffuse large B-cell lymphoma (DLBCL).
Materials and Methods
Ninety-two patients with stage III/IV or bulky DLBCL from 21 institutions were administered 8 cycles of R-CHOP-21 with an additional one dose of rituximab intensification on day 0 of the 1st cycle (RR-CHOP). The primary endpoint was a complete response (CR) rate after 3 cycles of chemotherapy.
Results
Among the 92 DLBCL patients assessed herein, the response rate after 3 cycles of chemotherapy was 88.0% (38.0% CR+50.0% partial response [PR]). After the completion of 8 cycles of chemotherapy, the overall response rate was observed for 68.4% (58.7% CR+9.8% PR). The 3-year progression-free survival rate was 64.0%, and the 3-year overall survival rate was 70.4%. Febrile neutropenia was one of the most frequent grade 3 adverse events (40.0%) and 5 treatment-related deaths occurred. Compared with the clinical outcomes of patients who received R-CHOP chemotherapy as a historical control, the interim CR rate was higher in male patients with RR-CHOP (20.5% vs. 48.8%, p=0.016).
Conclusion
Rituximab intensification on days 0 to the 1st cycle of the standard 8 cycles R-CHOP-21 for advanced DLBCL yielded favorable response rates after the 3 cycles of chemotherapy and acceptable toxicities, especially for male patients. ClinicalTrials.gov ID: NCT01054781.

Citations

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Design, Conduct, and Analysis of Externally Controlled Trials
Jiali Liu, Minghong Yao, Mingqi Wang, Wan Jie, Yanmei Liu, Xiaochao Luo, Jiayidaer Huan, Kelin Deng, Ke Deng, Kang Zou, Ying Zhang, Ling Li, Xin Sun
JAMA Network Open.2025; 8(9): e2530277. CrossRef

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Case Reports

Crohn’s Disease Following Rituximab Treatment for Follicular Lymphoma in a Patient with Synchronous Gastric Signet Ring Cells Carcinoma: A Case Report and Literature Review: Elisabetta Cavalcanti, Raffaele Armentano, Ivan Lolli; Cancer Res Treat. 2020;52(4):1291-1295. Published online July 13, 2020; DOI: https://doi.org/10.4143/crt.2020.406

Abstract PDF PubReader ePub

Recently, there have been a few reports of rituximab (RTX)-induced Crohn’s disease, but there is no literature available on successful long-term treatment and the clinical outcome of this condition. We retrospectively analyzed the clinical data of a rare case of Crohn’s disease induced by RTX administered as induction and prolonged maintenance therapy of a follicular lymphoma, diagnosed synchronously with a gastric signet ring cells carcinoma, treated at our hospital.

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Ocrelizumab-induced colitis—critical review and case series from a Romanian cohort of MS patients
Ileana Maria Vodă, Vlad Eugen Tiu, Luiza Răuță, Paul Ciucur, Andreea Ioana Mușuroi, Alina Flavia Tomescu, Nicoleta Laura Humă, Florin Dobrițoiu, Elena Terecoasă, Lucian Negreanu, Cristina Tiu
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Crohn's disease after multiple doses of rituximab treatment in a child with refractory nephrotic syndrome and an ATG2A mutation: a case report
Kaili Shi, Mengzhen Fu, Wei Xia, Pei Zhang, Chunlin Gao, Zhengkun Xia
Frontiers in Pediatrics.2024;[Epub] CrossRef
Rituximab-Induced Colitis and Esophagitis in a Patient With Granulomatosis With Polyangiitis
William K Boateng, Fomengia Joseph Nkeangu, Manlio H Castillo, Valentin Marian, Tingliang Shen
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Impact of Anti-CD20 therapies on the immune homeostasis of gastrointestinal mucosa and their relationship with de novo intestinal bowel disease in multiple sclerosis: a review
A. Quesada-Simó, A. Garrido-Marín, P. Nos, S. Gil-Perotín
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Successful treatment of a case with synchronous follicular lymphoma and gastric adenocarcinoma with CD19 CAR T cells and literature review
Jiaxin Liu, Fang Cao, Zhemin Li, Hongye Gao, Chen Zhang, Tingting Du, Ziyu Li, Yuqin Song, Jun Zhu, Zhitao Ying
Journal of Clinical Pharmacy and Therapeutics.2022; 47(9): 1466. CrossRef
Rituximab

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Progressive Multifocal Leukoencephalopathy after Ibrutinib Therapy for Chronic Lymphocytic Leukemia: Mathias Lutz, Arik B. Schulze, Elisabeth Rebber, Stefanie Wiebe, Tarek Zoubi, Oliver M. Grauer, Torsten Keßler, Andrea Kerkhoff, Georg Lenz, Wolfgang E. Berdel; Cancer Res Treat. 2017;49(2):548-552. Published online July 12, 2016; DOI: https://doi.org/10.4143/crt.2016.110

Abstract PDF PubReader ePub

Progressive multifocal leukoencephalopathy (PML) is a devastating neurological disease observed nearly exclusively in immunocompromised patients. Recently, the introduction of monoclonal antibodies significantly inhibiting the immune system such as rituximab has led to an increase in PML cases. Although rituximab-based immunochemotherapy remains the standard of treatment for chronic lymphocytic leukemia (CLL), the importance of Bruton’s tyrosine kinase inhibitors such as ibrutinib is steadily increasing. However, long-term experiences regarding possible side effects of these new substances are rare. Here, we report the development of eventually fatal PML possibly associated with ibrutinib therapy for CLL after multiple prior treatment lines, including rituximab. To the best of our knowledge, this is the first study to report such findings. Since the last course of rituximab was applied over 3 years ago, it is conceivable that the strong B cell inhibition by ibrutinib led to PML. With increased awareness of this potential side effect, further clinical studies are certainly warranted to evaluate this possible association.

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Progressive Multifocal Leukoencephalopathy Among Ibrutinib Treatment In Chronic Lymphocytic Leukemia
Tuğba Çetintepe, Füsun Gediz, Işın Akyar, Lutfi Çetintepe, Ali Murat Koç
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Original Articles

Clinical Significance of Non-neutropenic Fever in the Management of Diffuse Large B-Cell Lymphoma Patients Treated with Rituximab-CHOP: Comparison with Febrile Neutropenia and Risk Factor Analysis: Silvia Park, Cheol-In Kang, Doo Ryeon Chung, Kyong Ran Peck, Won Seog Kim, Seok Jin Kim; Cancer Res Treat. 2015;47(3):448-457. Published online November 3, 2014; DOI: https://doi.org/10.4143/crt.2014.034

Abstract PDF PubReader ePub

Purpose
Rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is the standard chemotherapy in diffuse large B-cell lymphoma (DLBCL) patients. Although febrile neutropenia (FN) is the major toxicity of this regimen, non-neutropenic fever (NNF) becomes an emerging issue. Materials and Methods We analyzed clinical features and outcomes of febrile complications from 397 patients with newly diagnosed DLBCL who were registered in the prospective cohort study. They had completed R-CHOP between September 2008 and January 2013. Results Thirty-nine patients (9.8%) had NNF whereas 160 patients (40.3%) had FN. Among them, 24 patients (6.0%) had both during their treatment. Compared to frequent occurrence of initial FN after the first cycle (> 50% of total events), more than 80% of NNF cases occurred after the third cycle. Interstitial pneumonitis comprised the highest proportion of NNF cases (54.8%), although the causative organism was not identified in the majority of cases. Thus, pathogen was identified in a limited number of patients (n=9), and Pneumocystis jiroveci pneumonia (PJP) was the most common. Considering that interstitial pneumonitis without documented pathogen could be clinically diagnosed with PJP, the overall rate of PJP including probable cases was 4.5% (18 cases from 397 patients). The NNF-related mortality rate was 10.3% (four deaths from 39 patients with NNF) while the FN-related mortality rate was only 1.3%. Conclusion NNF was observed with incidence of 10% during R-CHOP treatment, and showed different clinical manifestations with respect to the time of initial episode and causes.

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Incidence and risk factors of severe infections in diffuse large B-cell lymphoma patients undergoing immunochemotherapy
Haiqiu Zhao, Rong Su, Jie Luo, Lin Liu
Annals of Hematology.2025; 104(5): 2869. CrossRef
Interstitial lung disease presents with varying characteristics in patients with non-Hodgkin lymphoma undergoing rituximab-containing therapies
Wailong Zou, Jia Zhang, Yulin Li, Zhe Zhang, Rui Yang, Yaxin Yan, Weihua Zhu, Feng Ma, Piping Jiang, Yumin Wang, Xinjun Zhang, Jichao Chen
Annals of Hematology.2024;[Epub] CrossRef
The effect of ciprofloxacin prophylaxis during haematopoietic cell transplantation on infection episodes, exposure to treatment antimicrobials and antimicrobial resistance: a single-centre retrospective cohort study
Ioannis Baltas, Konstantinos Kavallieros, Giannis Konstantinou, Eirini Koutoumanou, Malick M Gibani, Mark Gilchrist, Frances Davies, Jiri Pavlu
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Infection profiles of different chemotherapy regimens and the clinical feasibility of antimicrobial prophylaxis in patients with DLBCL
Akihiro Ohmoto, Shigeo Fuji
Blood Reviews.2021; 46: 100738. CrossRef
Infectious complications during immunochemotherapy of post-transplantation lymphoproliferative disease–can we decrease the risk? Two case reports and review of literature
Aleksandra Gładyś, Sylwia Kozak, Kamil Wdowiak, Mateusz Winder, Jerzy Chudek
World Journal of Clinical Cases.2021; 9(3): 748. CrossRef
Incidence of Pneumocystis jirovecii pneumonia utilizing a polymerase chain reaction‐based diagnosis in patients receiving bendamustine
Mikhaila L. Rice, Jason N. Barreto, Carrie A. Thompson, Kristin C. Mara, Pritish K. Tosh, Andrew H. Limper
Cancer Medicine.2021; 10(15): 5120. CrossRef
Not all bad: Drug-induced interstitial pneumonia in DLBCL patients is potentially fatal but could be linked to better survival
Wen Wei, Yajie Zhu, Jianning Tang, Chuan Xu, Jiman Li, Shuya He, Zhihui Zhang, Ping Wu, Lei Luo, Qin Guo, Fang Li, Yuanrong Ren, Sisi Yu, Renqin Li, Li Li
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A phase II study of ibrutinib in combination with rituximab-cyclophosphamide-doxorubicin hydrochloride-vincristine sulfate-prednisone therapy in Epstein-Barr virus-positive, diffuse large B cell lymphoma (54179060LYM2003: IVORY study): results of the fina
Sang Eun Yoon, Seok Jin Kim, Dok Hyun Yoon, Youngil Koh, Yeung-Chul Mun, Young Rok Do, Yoon Seok Choi, Deok Hwan Yang, Min Kyoung Kim, Gyeong-Won Lee, Cheolwon Suh, Young Hyeh Ko, Won Seog Kim
Annals of Hematology.2020; 99(6): 1283. CrossRef
Prognostic significance of infectious episodes occurring during first‐line therapy for diffuse large B‐cell lymphoma ‐ A nationwide cohort study
Michael R. Clausen, Sinna P. Ulrichsen, Maja B. Juul, Christian B. Poulsen, Brian Iversen, Per T. Pedersen, Jakob Madsen, Robert S. Pedersen, Pär L. Josefsson, Jette S. Gørløv, Mette Nørgaard, Francesco d'Amore
Hematological Oncology.2020; 38(3): 318. CrossRef
Patterns of growth factor usage and febrile neutropenia among older patients with diffuse large B-cell non-Hodgkin lymphoma treated with CHOP or R-CHOP: the Intergroup experience (CALGB 9793; ECOG-SWOG 4494)
Vicki A. Morrison, Edie A. Weller, Thomas M. Habermann, Shuli Li, Richard I. Fisher, Bruce D. Cheson, Bruce A. Peterson
Leukemia & Lymphoma.2017; 58(8): 1814. CrossRef
Pneumocystispneumonia versus rituximab-induced interstitial lung disease in lymphoma patients receiving rituximab-containing chemotherapy
Se Yoon Park, Mi Young Kim, Won Jin Choi, Dok Hyun Yoon, Sang-Oh Lee, Sang-Ho Choi, Yang Soo Kim, Cheolwon Suh, Jun Hee Woo, Sung-Han Kim
Medical Mycology.2016; : myw095. CrossRef
Neoplastic fever in patients with bone and soft tissue sarcoma
Tomoki Nakamura, Akihiko Matsumine, Takao Matsubara, Kunihiro Asanuma, Akihiro Sudo
Molecular and Clinical Oncology.2016; 5(5): 631. CrossRef
Can mortality of cancer patients with fever and neutropenia be improved?
Karin A. Thursky, Leon J. Worth
Current Opinion in Infectious Diseases.2015; 28(6): 505. CrossRef

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Treatment Outcomes of Rituximab Plus Hyper-CVAD in Korean Patients with Sporadic Burkitt or Burkitt-like Lymphoma: Results of a Multicenter Analysis: Junshik Hong, Seok Jin Kim, Jae-Sook Ahn, Moo Kon Song, Yu Ri Kim, Ho Sup Lee, Ho-Young Yhim, Dok Hyun Yoon, Min Kyoung Kim, Sung Yong Oh, Yong Park, Yeung-Chul Mun, Young Rok Do, Hun-Mo Ryoo, Je-Jung Lee, Jae Hoon Lee, Won Seog Kim, Cheolwon Suh; Cancer Res Treat. 2015;47(2):173-181. Published online October 28, 2014; DOI: https://doi.org/10.4143/crt.2014.055

Abstract PDF PubReader ePub

Purpose
This study was conducted to evaluate outcomes in adult patients with Burkitt lymphoma (BL) or Burkitt-like lymphoma treated with an rituximab plus hyper-CVAD (R-hyper-CVAD) regimen by focusing on tolerability and actual delivered relative dose intensity (RDI).
Materials and Methods
Patients ≥ 20 years of age and pathologically diagnosed with BL or Burkitt-like lymphoma were treated with at least one cycle of R-hyper-CVAD as the first-line treatment in this study. Eligible patients’ case report forms were requested from their physicians to obtain clinical and laboratory data for this retrospective study.
Results
Forty-three patients (median age, 51 years) from 14 medical centers in Korea were analyzed, none of which were infected with human immunodeficiency virus. The majority of patients had advanced diseases, and 24 patients achieved a complete response (75.0%). After a median follow-up period of 20.0 months, 2-year event-free and overall survival rates were 70.9% and 81.4%, respectively. Eleven patients (25.6%) were unable to complete the R-hyper-CVAD regimen, including six patients due to early death. The RDIs of adriamycin, vincristine, methotrexate, and cytarabine were between 60% and 65%, which means less than 25% of patients received greater than 80% of the planned dose of each drug. Poor performance status was related to the lower RDIs of doxorubicin and methotrexate.
Conclusion
R-hyper-CVAD showed excellent treatment outcomes in patients who were suitable for dose-intense chemotherapy. However, management of patients who are intolerant to a dose-intense regimen remains problematic due to the frequent occurrence of treatmentrelated complications.

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Comparison of chemotherapy regimens plus rituximab in adult Burkitt lymphoma: A single-arm meta-analysis
Xiaoxuan Lu, Yu Liu, Ruyu Liu, Jiaxin Liu, Xiaojing Yan, Liren Qian
Frontiers in Oncology.2022;[Epub] CrossRef
Trends in survival of patients with stage I/II Burkitt lymphoma in the United States: A SEER database analysis
Ze‐Long Liu, Pan‐Pan Liu, Xi‐Wen Bi, De‐Xin Lei, Yu Wang, Zhi‐Ming Li, Wen‐Qi Jiang, Yi Xia
Cancer Medicine.2019; 8(3): 874. CrossRef
ERK-dependent IL-6 positive feedback loop mediates resistance against a combined treatment using danusertib and BKM120 in Burkitt lymphoma cell lines
Jun Liu, Junshik Hong, Kwang-Sung Ahn, Junhyeok Go, Heejoo Han, Jihyun Park, Dongchan Kim, Hyejoo Park, Youngil Koh, Dong-Yeop Shin, Sung-Soo Yoon
Leukemia & Lymphoma.2019; 60(10): 2532. CrossRef
Lymphoma epidemiology in Korea and the real clinical field including the Consortium for Improving Survival of Lymphoma (CISL) trial
Kwai Han Yoo, Hyewon Lee, Cheolwon Suh
International Journal of Hematology.2018; 107(4): 395. CrossRef
Recent advances in treating extra-ocular lymphomas
Lauge Hjorth Mikkelsen, Natacha Storm Würtz, Steffen Heegaard
Expert Review of Ophthalmology.2018; 13(4): 205. CrossRef
The Consortium for Improving Survival of Lymphoma (CISL): recent achievements and future perspective
Cheolwon Suh, Byeong-Bae Park, Won Seog Kim
Blood Research.2017; 52(1): 3. CrossRef
Primary lymphomas in the gastrointestinal tract
Jiang Chen Peng, Lu Zhong, Zhi Hua Ran
Journal of Digestive Diseases.2015; 16(4): 169. CrossRef

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Clinical Outcome of Rituximab-Based Therapy (RCHOP) in Diffuse Large B-Cell Lymphoma Patients with Bone Marrow Involvement: Byung Woog Kang, Joon Ho Moon, Yee Soo Chae, Soo Jung Lee, Jong Gwang Kim, Yeo-Kyeoung Kim, Je-Jung Lee, Deok-Hwan Yang, Hyeoung-Joon Kim, Jin Young Kim, Young Rok Do, Keon Uk Park, Hong Suk Song, Ki Young Kwon, Min Kyung Kim, Kyung Hee Lee, Myung Soo Hyun, Hun Mo Ryoo, Sung Hwa Bae, Hwak Kim, Sang Kyun Sohn; Cancer Res Treat. 2013;45(2):112-117. Published online June 30, 2013; DOI: https://doi.org/10.4143/crt.2013.45.2.112

Abstract PDF PubReader ePub

PURPOSE
We investigated the clinical outcome of bone marrow (BM) involvement in patients with diffuse large B-cell lymphoma (DLBCL) who received rituximab-based therapy.
MATERIALS AND METHODS
A total of 567 consecutive patients with newly diagnosed DLBCL treated with rituximab-CHOP (RCHOP) between November 2001 and March 2010 were included in the current study. All of the patients underwent a BM study at the initial staging and the clinical characteristics and prognosis of these patients with or without BM involvement were analyzed retrospectively.
RESULTS
The total cohort included 567 patients. The overall incidence of BM involvement was 8.5%. With a median follow-up duration of 33.2 months (range, 0.1 to 80.7 months) for patients who were alive at the last follow-up, the five-year overall survival (OS) and event-free survival (EFS) rate in patients without BM involvement (76.3% and 67.5%, p<0.001) was statistically higher than that in patients with BM involvement (44.3% and 40.1%, p<0.001). In multivariate analysis, among total patients, BM involvement showed a significant association with OS and EFS. In univariate and multivariate analyses, even among stage IV patients, a significant association with worse EFS was observed in the BM involvement group.
CONCLUSION
BM involvement at diagnosis affected the survival of patients with DLBCL who received RCHOP. Although use of RCHOP can result in significant improvement of the therapeutic effect of DLBCL, BM involvement is still a negative prognostic factor of DLBCL patients in the era of rituximab.

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Combination of Bone Marrow Biopsy and Flow Cytometric Analysis: The Prognostically Relevant Central Approach for Detecting Bone Marrow Invasion in Diffuse Large B-Cell Lymphoma
Haruya Okamoto, Nobuhiko Uoshima, Ayako Muramatsu, Reiko Isa, Takahiro Fujino, Yayoi Matsumura-Kimoto, Taku Tsukamoto, Shinsuke Mizutani, Yuji Shimura, Tsutomu Kobayashi, Eri Kawata, Hitoji Uchiyama, Junya Kuroda
Diagnostics.2021; 11(9): 1724. CrossRef
Assessment of CD52 expression in "double-hit" and "double-expressor" lymphomas: Implications for clinical trial eligibility
Jeffrey W. Craig, Michael J. Mina, Jennifer L. Crombie, Ann S. LaCasce, David M. Weinstock, Geraldine S. Pinkus, Olga Pozdnyakova, Francesco Bertolini
PLOS ONE.2018; 13(7): e0199708. CrossRef
HIV-infection impact on clinical–biological features and outcome of diffuse large B-cell lymphoma treated with R-CHOP in the combination antiretroviral therapy era
Maria Joao Baptista, Olga Garcia, Mireia Morgades, Eva Gonzalez-Barca, Pilar Miralles, Armando Lopez-Guillermo, Eugenia Abella, Miriam Moreno, Juan-Manuel Sancho, Evarist Feliu, Josep-Maria Ribera, Jose-Tomas Navarro
AIDS.2015; 29(7): 811. CrossRef
Non-Hodgkin Lymphomas: Impact of Rituximab on Overall Survival of Patients with Diffuse Large B-Cell and Follicular Lymphoma
José Carlos Jaime-Pérez, Carmen Magdalena Gamboa-Alonso, Alberto Vázquez-Mellado de Larracoechea, Marisol Rodríguez-Martínez, César Homero Gutiérrez-Aguirre, Luis Javier Marfil-Rivera, David Gómez-Almaguer
Archives of Medical Research.2015; 46(6): 454. CrossRef

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Case Reports

Hepatitis B Virus Reactivation in a Surface Antigen-negative and Antibody-positive Patient after Rituximab Plus CHOP Chemotherapy: Eui Bae Kim, Dae Sik Kim, Seh Jong Park, Yong Park, Kyoung Ho Rho, Seok Jin Kim; Cancer Res Treat. 2008;40(1):36-38. Published online March 31, 2008; DOI: https://doi.org/10.4143/crt.2008.40.1.36

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Rituximab is a monoclonal antibody that targets B-lymphocytes, and it is widely used to treat non-Hodgkin's lymphoma. However, its use has been implicated in HBV reactivation that's related with the immunosuppressive effects of rituximab. Although the majority of reactivations occur in hepatitis B carriers, a few cases of reactivation have been reported in HBsAg negative patients. However, reactivation in an HBsAg negative/HBsAb positive patient after rituximab treatment has never been reported in Korea. We present here an HBsAg-negative/HBsAb-positive 66-year-old female who displayed reactivation following rituximab plus CHOP chemotherapy for diffuse large B-cell lymphoma. While she was negative for HBsAg at diagnosis, her viral status was changed at the time of relapse as follows: HBsAg positive, HBsAb negative, HBeAg positive, HBeAb negative and an HBV DNA level of 1165 pg/ml. Our observation suggests that we should monitor for HBV reactivation during rituximab treatment when prior HBV infection or occult infection is suspected, and even in the HBsAg negative/HBsAb positive cases.

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Recurrence and influencing factors of hepatitis B surface antigen seroclearance induced by peginterferon alpha-based regimens
Rui Lu, Meng Zhang, Zi-Han Liu, Miao Hao, Yan Tian, Mei Li, Feng-Ping Wu, Wen-Jun Wang, Juan-Juan Shi, Xin Zhang, Xiao-Li Jia, Zi-Cheng Jiang, Xue-Mei Li, Guang-Hua Xu, Ya-Ping Li, Shuang-Suo Dang
World Journal of Gastroenterology.2024; 30(44): 4725. CrossRef
Very late-onset hepatitis B reactivation following chemoimmunotherapy
Edward R. Scheffer Cliff, Joe Sasadeusz, Kumar Visvanathan, Andrew Grigg
Leukemia & Lymphoma.2022; 63(4): 991. CrossRef
Development and validation of a nomogram for steroid-resistance prediction in immune thrombocytopenia patients
Jieni Yu, Zhiqiang Xu, Yuanyuan Zhuo, Huahua Wei, Yinhai Ye, Qinhong Xu, Youli Li, Lihong Yu, Weiying Feng, Pan Hong, Kejie Zhang
Hematology.2021; 26(1): 956. CrossRef
Hepatitis B virus reactivation with corticosteroid therapy in patients with adrenal insufficiency
Masako Hatano, Toshihide Mimura, Akira Shimada, Mitsuhiko Noda, Shigehiro Katayama
Endocrinology, Diabetes & Metabolism.2019;[Epub] CrossRef
Late reactivation of occult hepatitis B virus infection in a patient with chronic lymphocytic leukemia after rituximab and fludarabine-based regimen
Nuria Dominguez, Maria Luisa Manzano, Raquel Muñoz, Ana Martin, Inmaculada Fernandez, Gregorio Castellano
Leukemia & Lymphoma.2015; 56(4): 1160. CrossRef
Giving rituximab in patients with occult or resolved hepatitis B virus infection: are the current guidelines good enough?
Jesse Civan, Hie Won Hann
Expert Opinion on Drug Safety.2015; 14(6): 865. CrossRef
Management of patients with overt or resolved hepatitis B virus infection undergoing rituximab therapy
Mauro Viganò, Giampaolo Mangia, Pietro Lampertico
Expert Opinion on Biological Therapy.2014; 14(7): 1019. CrossRef
A Case of Reactivation of Hepatitis B and Fulminant Hepatitis which developed 3 months following Chemotherapy Including Rituximab in a Patient with Lymphoma
Tae Won Lim, Hee Taek Oh, Seung Un Song, Hae Won Lee, Ji Yeon Kim, Seon Ja Park
Kosin Medical Journal.2014; 29(2): 161. CrossRef
Occult Hepatitis B Virus Infection: Transmission and Reactivation
Sang Hee Song, Seong Gyu Hwang
The Korean Journal of Gastroenterology.2013; 62(3): 148. CrossRef
Reactivation of Hepatitis B Virus Following Systemic Chemotherapy for Malignant Lymphoma
Seung Jun Jang, Young Kul Jung, Hae Lim Baek, Hyun Hwa Yoon, Seung Kak Shin, Jun Shik Hong, Jin Ny Park, Oh Sang Kwon, Yun Soo Kim, Duck Joo Choi, Jae Hoon Lee, Ju Hyun Kim
Korean Journal of Medicine.2013; 85(6): 598. CrossRef
Occult Hepatitis B: Clinical Viewpoint and Management
Mehdi Zobeiri
Hepatitis Research and Treatment.2013; 2013: 1. CrossRef
Highly Sensitive Detection of Hepatitis B Virus Surface Antigen by Use of a Semiautomated Immune Complex Transfer Chemiluminescence Enzyme Immunoassay
Kazuhiko Takeda, Mari Maruki, Takahiro Yamagaito, Machiko Muramatsu, Yasuhiro Sakai, Hiroaki Tobimatsu, Hironori Kobayashi, Yoshiteru Mizuno, Yukio Hamaguchi
Journal of Clinical Microbiology.2013; 51(7): 2238. CrossRef
Reactivation of hepatitis B virus following rituximab-plus-steroid combination chemotherapy
Shigeru Kusumoto, Yasuhito Tanaka, Ryuzo Ueda, Masashi Mizokami
Journal of Gastroenterology.2011; 46(1): 9. CrossRef
Fulminant Hepatic Failure with Hepatitis B Virus Reactivation after Rituximab Treatment in a Patient with Resolved Hepatitis B
Seong Min Chung, Joo Hyun Sohn, Tae Yeob Kim, Ki Deok Yoo, Yong Woo Ahn, Joong Ho Bae, Yong Cheol Jeon, Jung Hye Choi
The Korean Journal of Gastroenterology.2010; 55(4): 266. CrossRef
Exacerbation of chronic idiopathic thrombocytopenic purpura following reactivation of an occult hepatitis B
Alessandro Allegra, Giuseppa Penna, Andrea Alonci, Angela Granata, Arianna D’Angelo, Caterina Musolino
Medical Oncology.2010; 27(3): 912. CrossRef

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A Case of Organizing Pneumonia Associated with Rituximab: Chi Hoon Maeng, Sang Ouk Chin, Byung Hyuk Yang, Si-young Kim, Hwi-Joong Youn, Kyung Sam Cho, Sun Kyung Baek, Sun Lee; Cancer Res Treat. 2007;39(2):88-91. Published online June 30, 2007; DOI: https://doi.org/10.4143/crt.2007.39.2.88

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Rituximab is a human/murine chimeric anti-CD20 monoclonal antibody used to treat CD20-positive B-cell non-Hodgkin's lymphoma (NHL). Although most of the adverse effects associated with rituximab are usually reversible and temporary infusion-related reactions, including fever, chills, flushing and skin reactions, there are several reports of pulmonary events after long-term administration of rituximab. We present a case of asymptomatic nodular organizing pneumonia occurring during rituximab-based chemotherapy in a patient with non-Hodgkin's lymphoma.

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The Korean Journal of Hematology.2009; 44(2): 108. CrossRef

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