This is in reference to the article on Drug Review – Rituximab [1]. The author had stated in the (Table I) children with CD 20+ Non Hodgkin Lymphoma, Rituximab can be administered and Level of evidence as 1a. It is not clear whether to use rituximab in newly diagnosed or in relapsed setting. Level 1a represents Systematic review (in homogeneity) randomized control trial [2]. Attiasa and Weitzmanb reported review of case series in children with relapsed CD 20+ NHL adding rituximab as salvage monotherapy or with chemotherapy showing activity [3]. Children’s Oncology Group (COG) added rituximab to chemotherapy in Pahse I/II study in relapsed and refractory setting, which showed good activity [4]. Children’s Oncology Group presented a abstract at American Society of Hematology in newly diagnosed CD 20+ NHL treated with chemotherapy + rituximab comparing with historic controls who received only chemotherapy, author had clearly concluded stating further randomized trials are required before adding rituximab to stanadard chemotherapy [5].The MabThera package information clearly states the safety and efficacy of MabThera (Rituximab) in children has not been established [6].

1. Borker A, Choudhary N. Rituximab. Indian Pediatr. 2011; 48:627-32.

2. Phillips B, Ball C, Sackett D, Badenoch D, Straus S, Haynes B, et al. Levels of evidence and grades of recommendation. Available from: URL: http://www.cebm.net/index.aspx?o=1025. Accessed on November 22nd, 2011.

3. Attiasa D, Weitzmanb S. The efficacy of rituximab in high- grade pediatric B-cell lymphoma/leukemia: a review of available evidence. Curr Opin Pediatr. 2008;20:17-22.

4. Griffin TC, Weitzman S, Weinstein H, Chang M, Cairo M, Hutchison R, et al. A study of rituximab and ifosfamide, carboplatin, and etoposide chemotherapy in children with recurrent/refractory B-cell (CD20+) non-Hodgkin lymphoma and mature B-cell acute lymphoblastic leukemia: report from the Children’s Oncology Group. Pediatr Blood Cancer. 2009;52:177-81.

5. Cairo MS, Lynch J, Harrison L, Van de ven C, Gross T, Shiramizu B, et al. Safety, efficacy and rituximab levels following chemoimmunotherapy (rituximab + FAB chemotherapy) in children and adolescents with mature B- cell Non-Hodgkin lymphoma (B-NHL): a Children’s Oncology Group report. Blood (ASH Meeting Abstracts). 2008;112:838.

6. European Medicines Agency. MabThera Product Information. Available from: URL: http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/000165/WC500025821.pdf. Accessed November 22nd, 2011.