Integrating Novel Therapies into Treatment of B-Cell Malignancies - Episode 3

Preventing Infusion Reactions With CD20 Antibodies in CLL

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Anti-CD20 antibodies, such as rituximab, obinutuzumab, and ofatumumab, have demonstrated good efficacy as treatments for patients with chronic lymphocytic leukemia (CLL), states Richard R Furman, MD. These antibodies have been studied in combination with chlorambucil in clinical studies, although Furman notes that it is unclear whether chlorambucil is necessary, particularly since it is an alkylating agent that may damage bone marrow.

Ofatumumab and obinutuzumab are generally well tolerated, but are associated with infusion reactions. It is important to choose patients wisely to identify individuals who are at high-risk for having an infusion reaction, notes Furman. Since patient selection is difficult, administration methods for lessening this adverse event should be utilized.

The original design of the obinutuzumab studies administered 1000 mg on day 1 but was altered to 100 mg on day 1 and 900 mg on day 2. Reducing the dose on the first day reduced lymphocytosis and dramatically improved tolerability, comments Furman. Also noteworthy is that the pivotal study involving idelalisib showed that administering idelalisib to patients as little as 2 hours before they were to receive their rituximab infusion reduced infusion reactions.