The Vaccine-Hesitant Moment
Rituximab dramatically improved the cure rate when it was combined with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) therapy in patients with DLBCL and mantle-cell lymphoma, reinforcing the notion of synergy among agents with distinct mechanisms of action.
Abstract
n engl j med 387;11 nejm.org September 15, 2022 1050 The authors reply: Figure 4 in our review article presents survival among consecutive patients according to date of diagnosis, without selection based on treatment or disease characteristics. Rituximab does not have major single-agent activity in diffuse large B-cell lymphoma (DLBCL) or mantle-cell lymphoma. However, when rituximab was combined with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) therapy in patients with DLBCL, it dramatically improved the cure rate, reinforcing the notion of synergy among agents with distinct mechanisms of action. In patients with mantle-cell lymphoma, rituximab improved the treatment outcome when it was added to other treatments in the contexts of initial or maintenance therapy and as salvage therapy. In the time period covered by the curves in Figure 4, other treatments (e.g., the use of autologous stem-cell transplantation as part of initial therapy and the incorporation of cytarabine into treatment regimens) might also have contributed to prolonged survival. However, rituximab was almost certainly a major factor. Mantle-cell lymphoma was only recognized as a specific clinical entity in 1991. The rather striking improvement in survival over the next two decades is a reflection of and testament to the power of clinical research to improve treatment outcomes when it is focused on a clearly and reproducibly defined disorder. James O. Armitage, M.D. University of Nebraska Omaha, NE joarmita@ unmc . edu