The case for rituximab in AIDS-related lymphoma.

not show significant differences in early infection risk compared with those recorded in the preceding (non–rituximab-containing) regimens. Similarly, in randomized prospective comparisons of fludarabine versus F-R, 6 fludarabine, cyclophosphamide and mitoxantrone (FCM) versus FCM-rituximab, 7 and fludarabine, mitoxantrone, dexamethasone (FND) versus FND-rituximab, 8 no excess in early infections was recorded in the rituximab-containing arms. We and others 9 have previously examined the risk of early or late infections among 160 patients receiving FC or FC-R, and have found no significant differences in infections either during chemo-therapy or in the first year of remission, even among patients at high predicted risk of infectious complications. In contradistinction to the results reported by the AIDS Malignancy Consortium, we did not observe significant increases in Herpes simplex, Varicella zoster, Pneumocytis jiroveci, or fungal infections among patients receiving FC-R, despite the lack of antimicrobial prophylaxis or growth-factor support in more than 70% of our patients. In conclusion, despite theoretical concerns about combined immunosuppression leading to increased infections in patients receiving combination fludarabine and rituximab therapy, there is little evidence at present to support this concern. One explanation for this apparent discrepancy may be related to the observation that prolonged CD4 lymphopenia following purine analog therapy is associated with lower infection risk than when similar levels are observed among patients with HIV infection. 10 Fludarabine and rituximab combinations are among the most potent regimens in the treatment of patients with indolent lymphoproliferative malignan-cies, and current safety data support the ongoing exploration of these promising regimens. References 1. Kaplan LD, Lee JY, Ambinder RF, et al. Rituximab does not improve clinical outcome in a randomized phase 3 trial of CHOP with or without rituximab in patients with HIV-associated non-Hodgkin lymphoma: AIDS-Malignancies Consortium Trial 010. Link BK, et al. Rituximab chimeric anti-CD20 monoclonal antibody therapy for relapsed indolent lymphoma: half of patients respond to a four-dose treatment program. et al. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. results of a chemoimmunotherapy regimen of fludarabine, cyclophosphamide, and rituximab as initial therapy for chronic lymphocytic leukemia. Adding rituximab to flu-darabine therapy for patients with untreated Chronic Lymphocytic Leukemia does not increase the risk of infection: Cancer and Leukemia Group B (CALGB) study 9712 [abstract]. phase 2 study of flu-darabine with concurrent versus sequential treatment with rituximab in symptomatic, untreated patients with B-cell chronic lymphocytic leukemia: results from Cancer and Leukemia Group B …