Addition of Fresh Frozen Plasma to Rituximab Induces a Major Clinical and Laboratory Response in Patients with Refractory Advanced CLL.

Rituximab (RTX) is a chimeric monoclonal antibody targeting the CD20 on B lymphocytes. It is effective in patients with B cell malignancies, but the response in CLL is inferior. We report 5 patients with advanced, therapy-resistant CLL, successfully treated by combining fresh frozen plasma (FFP) with standard-dose RTX. Patients. The patients’ data before treatment are summarized (Table1). Patient No.4, resistant only to Chlorambucil, had advanced disease and autoimmune hemolytic anemia with hemoglobin of 4gr/dL. Treatment. Treatment consisted of 2 units of FFP followed with standard-dose RTX: 375 mg/m², repeated every 4–8 weeks.

Results and comments. Post-treatment data are summarized in table 2. A major improvement of symptoms, a significant reduction of lymph nodes and splenomegaly and correction of anemia and thrombocytopenia without inducing neutropenia has been achieved. The response was durable. Patient 1 died of E. coli sepsis 4 months after the last cycle. Treatment-related toxicity was minimal. Patient 2 developed a moderate tumor lysis syndrome and transient thrombocytopenia. He is now in un-maintained hematological remission for over 15 months. Complement-dependent cell lysis (CDC) is one of the major mechanisms of the cytoreductive effect of RTX. Following our observation of a rapid and dramatic response to a combination of FFP and RTX in a patient with advanced CLL with very high WBC counts, refractory to alkylating agents, to Fludarabine, and to RTX both alone and in combination with chemotherapy [