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A Polymorphism in the Complement Component C1qA Correlates with Prolonged Response Following Rituximab Therapy of Follicular Lymphoma

Authors' Affiliations: ¹ Holden Comprehensive Cancer Center and Departments of ² Internal Medicine and ³ Statistics and Actuarial Science, University of Iowa, Iowa City, Iowa; ⁴ Division of Medical Oncology, Department of Internal Medicine, Stanford University School of Medicine, Stanford, California; and ⁵ Division of Hematology and ⁶ Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota

Requests for reprints: Emilian Racila, Holden Comprehensive Cancer Center at the University of Iowa, 5216MERF, University of Iowa, Iowa City, IA 52242. Phone: 319-335-7653; Fax: 319-335-8891; E-mail: emil-racila{at}uiowa.edu.

Purpose: Complement may play a role in the clinical response to rituximab and other monoclonal antibody–based therapies of cancer. The purpose of this study was to explore the relationship between the C1qA_[276] polymorphism and the clinical response to rituximab in patients with follicular lymphoma.

Experimental Design: Genotyping for C1qA_[276A/G] was done in 133 subjects with follicular lymphoma treated with single-agent rituximab, and correlation with clinical response was done using Cox regression analysis.

Results: Prolonged remission was observed among subjects that responded clinically to rituximab therapy and were carriers of the A allele compared with homozygous G subjects. Homozygous G subjects had a time to progression of 282 days, whereas A-allele carriers had a time to progression of 708 days [hazard ratio, (HR), 2.5; 95% confidence interval (95% CI), 2.0-3.1; P = 0.02]. Among subjects who achieved complete remission, homozygous G subjects had a time to progression of 250 days, whereas A-allele carriers had a time to progression of 1,118 days (HR, 4.5; 95% CI, 4.1-4.8, P = 0.04). The difference persisted after controlling for CD32 and CD16 polymorphisms. In patients who responded to rituximab used as first-line agent, a linear trend was observed among the C1qA_[276] genotypes, with homozygous A subjects achieving complete response at a higher rate compared with heterozygous or homozygous G subjects.

Conclusions: Our findings indicate that polymorphisms in the C1qA gene may affect the clinical response and duration of response to rituximab therapy of follicular lymphoma. These results could have direct implications on designing antibodies with improved efficiency and enhance our understanding of the role of complement in monoclonal antibody therapy.

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