Women respond much better than men to treatment of CFL with rituximab

Women respond much better than men to the treatment of chronic follicular lymphoma with a monoclonal antibody that targets CD20 (rituximab). These are the findings of a multi-centre, Austria-wide study by the Arbeitsgemeinschaft medikamentöse Tumortherapie (AGMT) carried out under the supervision of the University Department of Internal Medicine I and study leader Ulrich Jäger, which has now been published in the highly respected journal "Haematologica". It was also discovered that the volume of lymphoma cells has an important role to play.

Says Jäger: "This means that men with a large tumour or bone marrow infiltration respond poorest to antibody therapy, while women without bone marrow involvement and a small tumour respond best."

Follicular lymphoma is a chronic cancer of the lymphatic glands which frequently recurs after a temporary remission, i.e. a reduction in lymph node swelling and symptoms of illness. Around 40-50 new patients a year are treated for the condition at the University Department of Internal Medicine I. Follicular lymphoma primarily occurs in the lymph nodes or in the bone marrow.

Until now, it was only known that women with this condition generally have a better prognosis. "They have also fared particularly better, however, since the antibody Rituximab has been used as treatment," says the haematologist who is (currently) also the President of the European Hematology Association (EHA).

The study has shown that blood concentrations (serum concentrations) in women are around 20 per cent higher than in men over the period of treatment with Rituximab. Women achieve saturation of the blood concentration with the antibody during the fourth cycle of therapy, significantly earlier than male patients. 

"The next step must therefore be to carry out studies in which we give men this antibody more often or at a higher dose at the very start of treatment, in order to determine whether this improves the prognosis of male lymphoma patients," says Jäger. "We also need to look at other conditions in which antibodies are used in order to determine whether there is a similar gender-specific effect taking place." These studies are being planned.