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Cyclophosphamide + rituximab is a combination regimen consisting of the alkylating agent cyclophosphamide and the anti-CD20 monoclonal antibody rituximab. This combination is used primarily for induction therapy in diseases such as antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, including granulomatosis with polyangiitis and microscopic polyangiitis, as well as in certain B-cell malignancies. Cyclophosphamide acts by cross-linking DNA strands, leading to cell death, particularly in rapidly dividing cells. Rituximab targets CD20 on B lymphocytes, resulting in their depletion through mechanisms such as complement-dependent cytotoxicity (CDC), antibody-dependent cellular cytotoxicity (ADCC), and induction of apoptosis. The rationale for combining these agents is to target both mature B cells (with rituximab) and autoantibody-producing plasma cells or plasmablasts (with cyclophosphamide), thereby achieving more effective disease control[3][5][8].
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