Using rituximab in addition to standard chemotherapy has been reported to have beneficial effects on treatment outcome in patients with CD-20 positive malignant lymphomas. Rituximab is an anti-CD20 monoclonal antibody which is used to treat patients with B-cell non-Hodgkin’s lymphoma either alone or in combination with other drugs. It is active against both malignant and normal B-cells which express CD20 on their cell surface. It is also used in some types of auto-immune diseases such as rheumatoid arthritis. Due to its action against normal B-cells, rituximab causes immunosupression. This has lead to concerns that patients treated with this drug may be more susceptible to infection and there have been studies showing an increased risk of infection in these patients.
Lanini et al. carried out a systematic review and meta-analysis, published in BMC Medicine, to examine the current evidence on infections in patients with CD-20 positive malignant lymphomas treated with rituximab and standard chemotherapy.
To do this, they looked at randomized controlled trials involving adults with CD20 malignant lymphoma where patients had been randomized to receive either rituximab and chemotherapy or the same chemotherapy alone. After excluding poor quality studies, and those not fitting their inclusion criteria, they were able to examine 16 studies which included over 5000 patients.
Their results showed that the addition of rituximab to standard chemotherapy lead to a better treatment response without increasing the incidence of severe infection. They highlight that more research is needed to investigate the effect of rituximab on latent viral infections and in specific groups of patients, such as those with HIV or hepatitis.