17p deletion strongly influences rituximab elimination in chronic lymphocytic leukemia

Cristina Bagacean, Adrian Tempescul, David Ternant, Anne Banet, Nathalie Douet-Guilbert, Anne Bordron, Boutahar Bendaoud, Hussam Saad, Mihnea Zdrenghea, Christian Berthou, Gilles Paintaud, Yves Renaudineau, Cristina Bagacean, Adrian Tempescul, David Ternant, Anne Banet, Nathalie Douet-Guilbert, Anne Bordron, Boutahar Bendaoud, Hussam Saad, Mihnea Zdrenghea, Christian Berthou, Gilles Paintaud, Yves Renaudineau

Abstract

Chronic lymphocytic leukemia (CLL) is the most common type of leukemia and the anti-CD20 monoclonal antibody, rituximab, represents the therapeutic gold standard for more than 2 decades in this pathology, when used in combination with chemotherapy. However, some patients experience treatment resistance or rapid relapses, and in particular, those harboring a 17p/TP53 deletion (del(17p)). This resistance could be explained by a chemo-resistance, but it could also result from the direct impact of del(17p) on the pharmacokinetics of rituximab, which represents the aim of the present study. Accordingly, 44 CLL patients were included in the study, and among them 9 presented a del(17p). Next, a total of 233 rituximab sera were selected for a pharmacokinetic study and analyzed in a two-compartment model showing important differences when del(17p) CLL patients were compared with non-del(17p) patients treated with rituximab and chemotherapy: (1) clearance of rituximab was faster; (2) central volume of rituximab distribution V1 (peripheral blood) was reduced while peripheral volume V2 (lymphoid organs and tissues) was increased; and (3) the rate of rituximab elimination (Kout) was faster. In contrast, the group with a better prognosis harboring isolated del(13q) presented a slower rate of elimination (Kout). Pharmacokinetic parameters were independent from the other factors tested such as age, sex, chemotherapy regimen (fludarabine/cyclophosphamide versus bendamustine), IGHV mutational status, and FCGR3A 158VF status. In conclusion, this study provides an additional argument to consider that del(17p) is effective not only to control chemoresistance but also monoclonal antibody activity, based on higher rituximab turnover.

Trial registration: ClinicalTrials.gov NCT03294980.

Keywords: 17p deletion; Anti-CD20 monoclonal antibody; Chronic lymphocytic leukemia; Clearance; Pharmacokinetics; Rituximab.

Conflict of interest statement

Ethics approval and consent to participate

Consent was obtained from all individuals and the protocol approved by the Ethical Board (Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Del(17p) influences the pharmacokinetics of rituximab (RTX). Del(17p) CLL patients have a faster rituximab (RTX) clearance (CL) (a), a lower RTX distribution in the central volume (V1) (c) while peripheral volume (V2) was larger (d), and a significantly lower RTX rate of elimination (Kout) (b) compared to patients presenting other cytogenetic abnormalities. Statistics are indicated when p < 0.05 (Mann-Whitney U test)

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