SALVAGE TREATMENT WITH R-IEV (RITUXIMAB, IFOSFAMIDE, EPIRUBICIN, ETOPOSIDE) AND AUTOLOGOUS STEM CELL TRANSPLANT FOR RELAPSED/REFRACTORY DIFFUSE LARGE B-CELL LYMPHOMA
(Abstract release date: 05/19/16)
EHA Library. Gumenyuk S. 06/09/16; 134580; PB1680
Dr. Svitlana Gumenyuk
Contributions
Contributions
Abstract
Abstract: PB1680
Type: Publication Only
Background
The better salvage treatment before Autologous Stem Cell Transplant (ASCT) for relapsed/refractory Diffuse Large B-Cell Lymphoma (DLBCL) hasn’t been still definitively established. The phase III CORAL study, comparing R-ICE (Rituximab, Ifosfamide, Carboplatin, Etoposide) versus R-DHAP (Rituximab, Dexametasone, Cisplatin, Cytarabine) in relapsed DLBCL patients didn’t demonstrate a significant difference in terms of response rate and Progression-Free Survival (PFS) between the two groups. Therefore, the ESMO (European Society of Medical Oncology) guidelines recommend the use of R-ICE or R-DHAP or R-GDP (Rituximab, Gemcitabine, Dexamethasone, Cisplatin) as salvage regimen for relapsed/refractory DLBCL, considering the similar efficacy of all these treatment schemes.
Aims
The aim of the study was to evaluate the efficacy and safety of salvage treatment with R-IEV (Riruximab, Ifosfamide, Epirubicin, Etoposide and Dexamethasone) followed by ASCT in relapsed/refractory DLBCL patients.
Methods
From July 2007 to December 2015, 42 consecutive adult patients with relapsed (n=17) or refractory (n=25) DLBCL patients underwent a salvage treatment with three courses of R-IEV (Rituximab 375 mg/m2 on day 0, Ifosfamide 2500 mg/m2, Etoposide 150 mg/m2, Dexamethasone 20 mg, on days 1-3, Epirubicin 100 mg/m2 on day 1) every 21 days in two different Hematology Institutions of Rome (Regina Elena National Cancer Institute, n=20; San Giovanni Addolorata Hospital, n=22). For all patients we planned a Peripheral Blood hematopoietic Stem Cell (PBSC) harvest after the second or the third course of chemotherapy, if the bone marrow wasn’t or was involved at salvage treatment start, respectively, using Filgrastim or Lenograstim 5 mcg/Kg. All patients underwent a febrile neutropenia prophylaxis with Filgrastim (n=14), Lenograstim (n=18) or Pegfilgrastim (n=10) in all courses of treatment. All patients underwent a baseline evaluation of Performance Status (PS) and comorbidities, and left ventricular ejection assessment.
Results
The median age of patients at the start of salvage treatment was of 48 years (range: 23-62). At diagnosis, 38 patients (90%) were in advanced (III-IV) Ann-Arbor stage and 18 (43%) presented intermediate-high IPI score. Moreover, 35 patients (83%) had a 0-1 ECOG PS and 15 (36%) had not any relevant comorbidities. As first line treatment, 29 patients (69%) were treated with R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine and Prednisone), whereas the remaining 13 with other chemotherapeutic regimens. At the time of salvage treatment start, 25 patients (59%) were defined as refractory, 7 (17%) were relapsed within 12 months from the end of previous treatment line and 10 (24%) were relapsed after more than 12 months. After the end of R-IEV, a Complete Remission (CR) was obtained in 30 patients (71%), 9 patients were in Partial Response (PR, 21%), whereas the remaining 3 patients (8%) were defined as refractory to salvage treatment. PBSC collection was successfully performed in 40 patients, whereas in the remaining two wasn’t carry out for early progression (n=1) or harvest failure (n=1). Actually, 37 patients underwent ASCT after BEAM (Carmustine, Etoposide, Cytarabine, Melphalan) conditioning chemotherapy. Out of 40 patients in which a PBSC collection was successfully performed, three patients didn’t undergo ASCT for progression of disease (n=1), clinical choice (n=1) and patient refusal (n=1). A grade 3-4 neutropenia and a febrile neutropenia occurred in 78% and 31% of patients, respectively. However, we didn’t observe any cases of toxic death or cardiac relevant complication. After a median follow-up of 36 months (range: 3-116), the 2-year-PFS and OS (2y-PFS and 2y-OS) from the start of salvage treatment were of 73.8% and 83.3%, respectively.
Conclusion
From our experience, R-IEV salvage regimen with consequent ASCT was highly effective in relapsed/refractory DLBCL patients, permitting to obtain an impressive 2y-PFS, with a good safety profile. Further prospective randomized studies comparing R-IEV with other standard salvage regimens should be useful to establish the better therapeutic approach for these patients.
Session topic: E-poster
Keyword(s): Autologous hematopoietic stem cell transplantation, Relapsed lymphoma, Salvage chemotherapy
Type: Publication Only
Background
The better salvage treatment before Autologous Stem Cell Transplant (ASCT) for relapsed/refractory Diffuse Large B-Cell Lymphoma (DLBCL) hasn’t been still definitively established. The phase III CORAL study, comparing R-ICE (Rituximab, Ifosfamide, Carboplatin, Etoposide) versus R-DHAP (Rituximab, Dexametasone, Cisplatin, Cytarabine) in relapsed DLBCL patients didn’t demonstrate a significant difference in terms of response rate and Progression-Free Survival (PFS) between the two groups. Therefore, the ESMO (European Society of Medical Oncology) guidelines recommend the use of R-ICE or R-DHAP or R-GDP (Rituximab, Gemcitabine, Dexamethasone, Cisplatin) as salvage regimen for relapsed/refractory DLBCL, considering the similar efficacy of all these treatment schemes.
Aims
The aim of the study was to evaluate the efficacy and safety of salvage treatment with R-IEV (Riruximab, Ifosfamide, Epirubicin, Etoposide and Dexamethasone) followed by ASCT in relapsed/refractory DLBCL patients.
Methods
From July 2007 to December 2015, 42 consecutive adult patients with relapsed (n=17) or refractory (n=25) DLBCL patients underwent a salvage treatment with three courses of R-IEV (Rituximab 375 mg/m2 on day 0, Ifosfamide 2500 mg/m2, Etoposide 150 mg/m2, Dexamethasone 20 mg, on days 1-3, Epirubicin 100 mg/m2 on day 1) every 21 days in two different Hematology Institutions of Rome (Regina Elena National Cancer Institute, n=20; San Giovanni Addolorata Hospital, n=22). For all patients we planned a Peripheral Blood hematopoietic Stem Cell (PBSC) harvest after the second or the third course of chemotherapy, if the bone marrow wasn’t or was involved at salvage treatment start, respectively, using Filgrastim or Lenograstim 5 mcg/Kg. All patients underwent a febrile neutropenia prophylaxis with Filgrastim (n=14), Lenograstim (n=18) or Pegfilgrastim (n=10) in all courses of treatment. All patients underwent a baseline evaluation of Performance Status (PS) and comorbidities, and left ventricular ejection assessment.
Results
The median age of patients at the start of salvage treatment was of 48 years (range: 23-62). At diagnosis, 38 patients (90%) were in advanced (III-IV) Ann-Arbor stage and 18 (43%) presented intermediate-high IPI score. Moreover, 35 patients (83%) had a 0-1 ECOG PS and 15 (36%) had not any relevant comorbidities. As first line treatment, 29 patients (69%) were treated with R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine and Prednisone), whereas the remaining 13 with other chemotherapeutic regimens. At the time of salvage treatment start, 25 patients (59%) were defined as refractory, 7 (17%) were relapsed within 12 months from the end of previous treatment line and 10 (24%) were relapsed after more than 12 months. After the end of R-IEV, a Complete Remission (CR) was obtained in 30 patients (71%), 9 patients were in Partial Response (PR, 21%), whereas the remaining 3 patients (8%) were defined as refractory to salvage treatment. PBSC collection was successfully performed in 40 patients, whereas in the remaining two wasn’t carry out for early progression (n=1) or harvest failure (n=1). Actually, 37 patients underwent ASCT after BEAM (Carmustine, Etoposide, Cytarabine, Melphalan) conditioning chemotherapy. Out of 40 patients in which a PBSC collection was successfully performed, three patients didn’t undergo ASCT for progression of disease (n=1), clinical choice (n=1) and patient refusal (n=1). A grade 3-4 neutropenia and a febrile neutropenia occurred in 78% and 31% of patients, respectively. However, we didn’t observe any cases of toxic death or cardiac relevant complication. After a median follow-up of 36 months (range: 3-116), the 2-year-PFS and OS (2y-PFS and 2y-OS) from the start of salvage treatment were of 73.8% and 83.3%, respectively.
Conclusion
From our experience, R-IEV salvage regimen with consequent ASCT was highly effective in relapsed/refractory DLBCL patients, permitting to obtain an impressive 2y-PFS, with a good safety profile. Further prospective randomized studies comparing R-IEV with other standard salvage regimens should be useful to establish the better therapeutic approach for these patients.
Session topic: E-poster
Keyword(s): Autologous hematopoietic stem cell transplantation, Relapsed lymphoma, Salvage chemotherapy
Abstract: PB1680
Type: Publication Only
Background
The better salvage treatment before Autologous Stem Cell Transplant (ASCT) for relapsed/refractory Diffuse Large B-Cell Lymphoma (DLBCL) hasn’t been still definitively established. The phase III CORAL study, comparing R-ICE (Rituximab, Ifosfamide, Carboplatin, Etoposide) versus R-DHAP (Rituximab, Dexametasone, Cisplatin, Cytarabine) in relapsed DLBCL patients didn’t demonstrate a significant difference in terms of response rate and Progression-Free Survival (PFS) between the two groups. Therefore, the ESMO (European Society of Medical Oncology) guidelines recommend the use of R-ICE or R-DHAP or R-GDP (Rituximab, Gemcitabine, Dexamethasone, Cisplatin) as salvage regimen for relapsed/refractory DLBCL, considering the similar efficacy of all these treatment schemes.
Aims
The aim of the study was to evaluate the efficacy and safety of salvage treatment with R-IEV (Riruximab, Ifosfamide, Epirubicin, Etoposide and Dexamethasone) followed by ASCT in relapsed/refractory DLBCL patients.
Methods
From July 2007 to December 2015, 42 consecutive adult patients with relapsed (n=17) or refractory (n=25) DLBCL patients underwent a salvage treatment with three courses of R-IEV (Rituximab 375 mg/m2 on day 0, Ifosfamide 2500 mg/m2, Etoposide 150 mg/m2, Dexamethasone 20 mg, on days 1-3, Epirubicin 100 mg/m2 on day 1) every 21 days in two different Hematology Institutions of Rome (Regina Elena National Cancer Institute, n=20; San Giovanni Addolorata Hospital, n=22). For all patients we planned a Peripheral Blood hematopoietic Stem Cell (PBSC) harvest after the second or the third course of chemotherapy, if the bone marrow wasn’t or was involved at salvage treatment start, respectively, using Filgrastim or Lenograstim 5 mcg/Kg. All patients underwent a febrile neutropenia prophylaxis with Filgrastim (n=14), Lenograstim (n=18) or Pegfilgrastim (n=10) in all courses of treatment. All patients underwent a baseline evaluation of Performance Status (PS) and comorbidities, and left ventricular ejection assessment.
Results
The median age of patients at the start of salvage treatment was of 48 years (range: 23-62). At diagnosis, 38 patients (90%) were in advanced (III-IV) Ann-Arbor stage and 18 (43%) presented intermediate-high IPI score. Moreover, 35 patients (83%) had a 0-1 ECOG PS and 15 (36%) had not any relevant comorbidities. As first line treatment, 29 patients (69%) were treated with R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine and Prednisone), whereas the remaining 13 with other chemotherapeutic regimens. At the time of salvage treatment start, 25 patients (59%) were defined as refractory, 7 (17%) were relapsed within 12 months from the end of previous treatment line and 10 (24%) were relapsed after more than 12 months. After the end of R-IEV, a Complete Remission (CR) was obtained in 30 patients (71%), 9 patients were in Partial Response (PR, 21%), whereas the remaining 3 patients (8%) were defined as refractory to salvage treatment. PBSC collection was successfully performed in 40 patients, whereas in the remaining two wasn’t carry out for early progression (n=1) or harvest failure (n=1). Actually, 37 patients underwent ASCT after BEAM (Carmustine, Etoposide, Cytarabine, Melphalan) conditioning chemotherapy. Out of 40 patients in which a PBSC collection was successfully performed, three patients didn’t undergo ASCT for progression of disease (n=1), clinical choice (n=1) and patient refusal (n=1). A grade 3-4 neutropenia and a febrile neutropenia occurred in 78% and 31% of patients, respectively. However, we didn’t observe any cases of toxic death or cardiac relevant complication. After a median follow-up of 36 months (range: 3-116), the 2-year-PFS and OS (2y-PFS and 2y-OS) from the start of salvage treatment were of 73.8% and 83.3%, respectively.
Conclusion
From our experience, R-IEV salvage regimen with consequent ASCT was highly effective in relapsed/refractory DLBCL patients, permitting to obtain an impressive 2y-PFS, with a good safety profile. Further prospective randomized studies comparing R-IEV with other standard salvage regimens should be useful to establish the better therapeutic approach for these patients.
Session topic: E-poster
Keyword(s): Autologous hematopoietic stem cell transplantation, Relapsed lymphoma, Salvage chemotherapy
Type: Publication Only
Background
The better salvage treatment before Autologous Stem Cell Transplant (ASCT) for relapsed/refractory Diffuse Large B-Cell Lymphoma (DLBCL) hasn’t been still definitively established. The phase III CORAL study, comparing R-ICE (Rituximab, Ifosfamide, Carboplatin, Etoposide) versus R-DHAP (Rituximab, Dexametasone, Cisplatin, Cytarabine) in relapsed DLBCL patients didn’t demonstrate a significant difference in terms of response rate and Progression-Free Survival (PFS) between the two groups. Therefore, the ESMO (European Society of Medical Oncology) guidelines recommend the use of R-ICE or R-DHAP or R-GDP (Rituximab, Gemcitabine, Dexamethasone, Cisplatin) as salvage regimen for relapsed/refractory DLBCL, considering the similar efficacy of all these treatment schemes.
Aims
The aim of the study was to evaluate the efficacy and safety of salvage treatment with R-IEV (Riruximab, Ifosfamide, Epirubicin, Etoposide and Dexamethasone) followed by ASCT in relapsed/refractory DLBCL patients.
Methods
From July 2007 to December 2015, 42 consecutive adult patients with relapsed (n=17) or refractory (n=25) DLBCL patients underwent a salvage treatment with three courses of R-IEV (Rituximab 375 mg/m2 on day 0, Ifosfamide 2500 mg/m2, Etoposide 150 mg/m2, Dexamethasone 20 mg, on days 1-3, Epirubicin 100 mg/m2 on day 1) every 21 days in two different Hematology Institutions of Rome (Regina Elena National Cancer Institute, n=20; San Giovanni Addolorata Hospital, n=22). For all patients we planned a Peripheral Blood hematopoietic Stem Cell (PBSC) harvest after the second or the third course of chemotherapy, if the bone marrow wasn’t or was involved at salvage treatment start, respectively, using Filgrastim or Lenograstim 5 mcg/Kg. All patients underwent a febrile neutropenia prophylaxis with Filgrastim (n=14), Lenograstim (n=18) or Pegfilgrastim (n=10) in all courses of treatment. All patients underwent a baseline evaluation of Performance Status (PS) and comorbidities, and left ventricular ejection assessment.
Results
The median age of patients at the start of salvage treatment was of 48 years (range: 23-62). At diagnosis, 38 patients (90%) were in advanced (III-IV) Ann-Arbor stage and 18 (43%) presented intermediate-high IPI score. Moreover, 35 patients (83%) had a 0-1 ECOG PS and 15 (36%) had not any relevant comorbidities. As first line treatment, 29 patients (69%) were treated with R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine and Prednisone), whereas the remaining 13 with other chemotherapeutic regimens. At the time of salvage treatment start, 25 patients (59%) were defined as refractory, 7 (17%) were relapsed within 12 months from the end of previous treatment line and 10 (24%) were relapsed after more than 12 months. After the end of R-IEV, a Complete Remission (CR) was obtained in 30 patients (71%), 9 patients were in Partial Response (PR, 21%), whereas the remaining 3 patients (8%) were defined as refractory to salvage treatment. PBSC collection was successfully performed in 40 patients, whereas in the remaining two wasn’t carry out for early progression (n=1) or harvest failure (n=1). Actually, 37 patients underwent ASCT after BEAM (Carmustine, Etoposide, Cytarabine, Melphalan) conditioning chemotherapy. Out of 40 patients in which a PBSC collection was successfully performed, three patients didn’t undergo ASCT for progression of disease (n=1), clinical choice (n=1) and patient refusal (n=1). A grade 3-4 neutropenia and a febrile neutropenia occurred in 78% and 31% of patients, respectively. However, we didn’t observe any cases of toxic death or cardiac relevant complication. After a median follow-up of 36 months (range: 3-116), the 2-year-PFS and OS (2y-PFS and 2y-OS) from the start of salvage treatment were of 73.8% and 83.3%, respectively.
Conclusion
From our experience, R-IEV salvage regimen with consequent ASCT was highly effective in relapsed/refractory DLBCL patients, permitting to obtain an impressive 2y-PFS, with a good safety profile. Further prospective randomized studies comparing R-IEV with other standard salvage regimens should be useful to establish the better therapeutic approach for these patients.
Session topic: E-poster
Keyword(s): Autologous hematopoietic stem cell transplantation, Relapsed lymphoma, Salvage chemotherapy
{{ help_message }}
{{filter}}