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QJM Advance Access published online on July 23, 2008
QJM, doi:10.1093/qjmed/hcn085
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© The Author 2008. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Adding fresh frozen plasma to rituximab for the treatment of patients with refractory advanced CLL

A. Klepfish1, E.A. Rachmilewitz1, I. Kotsianidis2, P. Patchenko1 and A. Schattner3

From the 1Blood Bank and Haematology Department, E. Wolfson Medical Centre, Holon, 2The Haematology Department, Democritus University of Thrace School of Medicine, Alexandroupolis, Greece and 3The Hebrew University Hadassah Medical School, Jerusalem, Israel

Address correspondence to Dr Abraham Klepfish, Blood Bank and Haematology Department, Wolfson Medical Centre, Holon. email: kelpfish{at}wolfson.health.gov.il or to Prof. Ami Schattner, Head, Department of Medicine, Kaplan Medical Centre, POB 1 Rehovot 76100, The Faculty of Medicine, Hebrew University Hadassah Medical School, Jerusalem, Israel. email: amiMD{at}clalit.org.il

Received 6 May 2008 and in revised form 16 June 2008


  Abstract

Background: Many patients with chronic lymphocytic leukaemia (CLL) develop progressive, treatment-resistant disease. Rituximab (RTX), a monoclonal antibody targeting CD20 on B lymphocytes and widely used in other indolent B cell neoplasms is less efficacious in CLL, possibly due to associated complement deficiencies.

Objective: To examine in open trial whether providing complement by concurrent administration of fresh frozen plasma (FFP) will enhance the effect of RTX in CLL.

Setting: Outpatient haematology clinics in Israel and Greece.

Patients: Five patients with severe treatment-resistant CLL. All had been previously treated with fludarabine and three also failed treatment with RTX.

Intervention: Two units of FFP followed with RTX 375 mg/m2 as a single agent, repeated every 1–2 weeks, as needed.

Results: A rapid and dramatic clinical and laboratory response was achieved in all patients. Lymphocyte counts dropped markedly followed by shrinkage of lymph nodes and spleen and improvement of the anaemia and thrombocytopenia. This could be maintained over 8 months (median) with additional cycles if necessary. Treatment was well tolerated in all cases.

Conclusion: Adding FFP to RTX may provide a useful therapeutic option in patients with advanced CLL resistant to treatment.


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