Adding fresh frozen plasma to rituximab for the treatment of patients with refractory advanced CLL.
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/m(2) 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.