my mother has hodgkins disease, 3 months ago, the LNDs BX shows ( CD 20 possitive ), she is treated on ABVD, the plan is 12 sessions to make 6 cycles, what about Mabthira to be combinated with ABVD in the first line???

ossama:
I'm sorry to hear about your mother's diagnosis.

Rituximab (sold under the brand names Rituxan and MabThera) is not FDA-approved to treat Hodgkins in the US, but this doesn't mean it hasn't been used off-label for Hodgkins. According to the Mayo Clinic, Rituximab has been shown to produce good results for people with Hodgkins lymphoma in a pair of completed clinical trials. When, by itself, administered to patients with relapsed Hodgkins, it did produce remission for some of them. Another study found that patients with newly diagnosed Hodgkins, treated with Rituximab+ABVD—just as you're suggesting—produced "higher response rates than would be expected with ABVD alone … [however] It is also not well understood how the rituximab might actually work in treating Hodgkin lymphoma."

Not surprisingly, the website for MabThera makes no mention of Hodgkins. Same goes for Rituxan's website. Naturally that won't change until it receives FDA approval for Hodgkins.

As for why your mother's doctors are not adding rituximab to the ABVD regimen, only they know, but one likely reason is because it is not an established treatment protocol right now. They may or may not be aware of the studies mentioned by the Mayo Clinic; they may believe that your mother, for some reason, won't respond well to rituximab; they may have simply decided directly on ABVD since it's considered the gold standard for treating Hodgkins.

I would suggest asking her doctors about it, and asking them to explain why she would or would not be a good candidate for adding rituximab.

Finally, you should be aware of the fact that there are a number of clinical trials either ongoing or in the works that are examining the effectiveness of rituximab in treating Hodgkins. For instance:

--There is an ongoing Phase II clinical trial examining the effectiveness of Rituxan+ABVD scheduled to be completed at the end of 2009.

--A trial looking at the same thing will soon begin at Sloan-Kettering Cancer Center.

--There is another Phase II clinical trial that hasn't begun to recruit participants yet which will divide Hodgkins patients into two groups: one will get Rituxan only for 8 weeks, while the other will get ABVD for 12 weeks. The hypothesis of this trial is that those getting only Rituxan will see a quicker remission of their Hodgkins lymphoma than those getting the standard ABVD.

I mention these so that you can mention them to her doctors, and I mention them to encourage you and your mother to consider one of them should her chemo regimen either be ineffective, or effective only to have her relapse.

Best of luck,
Ross

My 13 year old son is considered to have refractory Hodgkins Lymphoma. He was diagnosed with Stage IIIB Hodgkins Lymphoma in Sept 08. He was responding quite well to initial therapy of ABV-COPP until the 4th month when a new node appeared in his neck. They took him off front line treatment and administered Ifosfamide and Vinorelbine. This was not effective. I researched a new drug SGN-35 and we participated in a clinical trial for 3 months where the scans revealed a mixed response to this treatment. My son is now receiving Doxil, Bortezomib and Gemcitibine. My question is, because he had the best response from his intial treatment (more than 50% reduction on tumors), would it be wise to increase the dose and switch him back to ABV-COPP or BEACOPP or some other front line treatment. Another question I have is would he be considered a good candidate for a allogenic transplant? Does Hodgkins have a good response rate to that, and would we then be relying on graph vs Hodgkins to cure him?

Thanks
Jennifer