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Combination Immunotherapy of B-Cell Non-Hodgkin’s Lymphoma with Rituximab and Interleukin-2

A Preclinical and Phase I Study

¹ Division of Hematology/Oncology, ² Comprehensive Cancer Center, and ³ Center for Biostatistics, The Ohio State University, Columbus, Ohio; and ⁴ Cancer Therapy Evaluation Program, National Cancer Institute, Rockville, Maryland

Purpose: Cytokine-induced modulation of innate immunity is being explored to enhance the activity of monoclonal antibodies. Severe combined immunodeficient (SCID) mice engrafted with peripheral blood leukocytes (PBLs) from Epstein Barr virus-seropositive donors develop human B-cell non-Hodgkin’s lymphomas [B-NHLs (hu-PBL-SCID mouse model)]. We used this hu-PBL-SCID mouse model to study the synergism between interleukin (IL)-2 and rituximab. We also conducted a phase I trial of IL-2 and rituximab in relapsed B-NHL to study whether expansion of natural killer (NK) cells and enhanced cellular cytotoxicity could be safely accomplished in vivo.

Experimental Design: Hu-PBL-SCID mice were treated with various schedules of rituximab and IL-2, with survival as the end point. Patients with relapsed B-NHL received rituximab (375 mg/m² weekly x 4) followed by daily low-dose IL-2 (1 MIU/m²/day x 4 weeks) with pulses of intermediate-dose IL-2 (3–15 MIU/m²). Toxicity, NK cell numbers, and cellular cytotoxicity were measured.

Results: In the hu-PBL-SCID mouse, the combination of rituximab and IL-2 showed greater activity against B-NHL than either agent alone. Treatment was most effective when IL-2 was given before rituximab. Twelve patients with heavily pretreated B-NHL entered the phase I trial. Toxicity was manageable, and responses were observed. NK cell expansion and enhanced cellular cytotoxicity against a B-cell lymphoma target were observed but did not correlate with response.

Conclusions: The combination of IL-2 and rituximab is synergistic against B-NHL in the hu-PBL-SCID model. In the phase I trial, a sequential combination of rituximab and IL-2 was well tolerated and achieved biological end points. Responses were observed.

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