This is a compilation of results of important clinical trials those have used Rituximab in patients of pre-B ALL (BCR ABL negative or positive). This includes studies from MDACC USA, French group GRAALL, UKALL14 and also from TMH Mumbai, India.

1. Rituximab in ALL

2. September 15, 2016
April 2022

4. Rituximab in B-ALL
Centre/
Trial
Year of
publicati
on
No. of
patients
Inclusion Backbon
e
CD20
expressi
on
Rituxima
b total
doses
Rituxima
b
schedule
CR/MRD
neg rates
OS EFS
MDACC 2010 282 Ph-ve
>10yr
Hyper-
CVAD
>20% 12 In
protocol
No diff 3yr OS
75% vs
47%
historical
P=0.003
GRAALL 2005 209 Ph-ve
18-59yr
GRAALL >20% 16-18 In
protocol
CR/MRD-
No diff
HR=0.7
p=0.1
HR=0.66
p=0.04
UKALL14 2022 586 Ph+/-
19-65yr
UKALL14 Any
CD20
4 day 3,
10, 17,
24
CR/
MRD- No
diff
- 3yr EFS
43.7 Vs
51.4
TMH,
Mumbai
2021 35 Ph-ve
>14yr
BFM-90
(Ritux+
Bort)
>20% 5 day 1, 8,
15, 22,
28
CR- 85.3%
Vs 70%.
MRD neg-
70.9% Vs
51.7%
historical
21m
78.8%
21m
78.7%

5. Salient points
Steroids upregulate CD 20 expression
So level of expression of CD 20 may not make a difference
So logical to use R after few days of steroids
Benefit or R irrespective of Ph status
4 doses are inadequate for OS benefit
R can decrease anti-L-asp Ab formation & thus resistance