An elderly patient is diagnosed with aggressive non-Hodgkin's lymphoma. The tumor cells are shown to stain strongly for the CD20 marker. Which of the following biologic agents can be added to this patient's chemotherapy regimen to help improve the treatment response?

Question

An elderly patient is diagnosed with aggressive non-Hodgkin's lymphoma.  The tumor cells are shown to stain strongly for the CD20 marker.  Which of the following biologic agents can be added to this patient's chemotherapy regimen to help improve the treatment response?

Quizplus · Accepted Answer

The class of treatments known as biologic response modifiers (BRMs) includes antibodies, cytokines and other substances intended to restore or induce the immune system's ability to overcome disease. All of the answer choices here are BRMs. The patient described above has a lymphoma that expresses surface CD20, a B-cell marker. Rituximab is a monoclonal antibody used in lymphoma immunotherapy that specifically targets the CD20 surface immunoglobulin. Another monoclonal antibody used in cancer treatment is trastuzumab (Herceptin), which is used in the treatment of breast cancer. (Choice A) Infliximab is a chimeric (human/murine) IgG1 monoclonal antibody to TNF-alpha. This medication has had a significant impact on the management of rheumatoid arthritis. Infliximab is also used to treat ankylosing spondylitis and fistulizing Crohn's disease. (Choice C) Interleukin-2 is a cytokine that regulates the activation and differentiation of T-cells to aid in tumor cell destruction. It is FDA-approved for the treatment of renal cell carcinoma and melanoma. (Choice D) Diagnosis of CML requires the presence of the Philadelphia chromosome or the BCR/ABL fusion gene. Imatinib mesylate is a potent inhibitor of the BCR/ABL protein tyrosine kinase. It inhibits the cellular proliferation of BCR/ABL-expressing cells without inducing apoptosis. This oral medication has dramatically changed the management of CML since its introduction. (Choice E) Abciximab is a chimeric mouse-human monoclonal antibody against the platelet GP IIb/IIIa receptor. It works by blocking the final step in platelet aggregation. Abciximab is often administered during angioplasty in patients with acute coronary syndrome. Educational Objective: Rituximab is a monoclonal antibody directed against the CD20 antigen. Its introduction has improved the prognosis of some lymphomas.

An Elderly Patient Is Diagnosed with Aggressive Non-Hodgkin's Lymphoma