Contributions
Abstract: EP555
Type: E-Poster Presentation
Session title: Aggressive Non-Hodgkin lymphoma - Clinical
Background
The combination chemotherapy incorporating polatuzumab along with rituximab and Bendamustine has shown a significant response in relapsed /refractory high grade lymphoma. .
Aims
To review the response of all patients who received rituximab, polatuzamab and bendamustine (RPB) for relapsed /refractory diffuse large B cell lymphoma (DLBCL) and transformed high grade lymphoma in 4 district general hospitals in the East Anglia Cancer Network.
Methods
Retrospective analysis of data from 4 district general hospitals which serves a population of 1.26 million. All patients who had combination chemotherapy of rituximab, polatuzumab and bendamustine as stand-alone treatment or for bridging to Chimeric Antigen Receptor T cell (CAR T) therapy were identified from from June 2019. Patients were given 1.8mg/kg of polatuzumab, 375mg/m2 of rituximab on day 1 and 90mg/m2 of Bendamustine on day 1 and day 2 in a three weekly cycle. Objective clinical and radiological responses were assessed using modified Lugano Classification on interim staging CT scan after 3 cycles of treatment and positron emission tomography (PET) scan at the end of treatment.
Results
A total of 24 patients were identified from four district general hospitals in the East of Anglia Cancer Network. The mean age is 70.6 years (range 27-87) with M:F ratio of 2:1. The median ECOG was 2. De novo cases constituted 66% (16/24) of the patients. 29.1% (7/24) of the patients had transformed low grade lymphoma – 5 from follicular lymphoma and 1 each from marginal zone lymphoma and chronic lymphocytic lymphoma). There was 1 patient with primary mediastinal B cell lymphoma. 62.5% (15/24) of the patients had stage IV disease and 20% (5/24) of the patients had stage III disease. 16% (4/24) of patients had bulky disease prior to RBP cytotoxic chemotherapy. 75% (18/24) of the patients had extranodal involvement ranging from 1-5 extranodal sites. Mean IPI of the study group was 2.83. 29% (7/24) had double expresser phenotype on immunohistochemistry with 1 case of double hit lymphoma. Mean number of lines of therapy before RBP was 1.73. Only one patient was exposed to Bendamustine prior to RBP. All patients has had rituximab combination as a line of prior therapy and 37% (9/24) of patients were refractory to RCHOP chemotherapy. 54% (13/24) of patients were refractory to one line of prior therapy. 62.5% (15/24) of patients had less than 12 months of remission before RBP therapy. None of the patients had CAR T, autologous or allogeneic bone marrow transplant prior to the therapy. 75% (18/24) patients had the treatment as a standalone treatment, while 25% (6/24) had RBP as a bridge to CAR T cell therapy. In the standalone group, the median number of cycles of RBP was 4.33 with infection and peripheral neuropathy manifested in 3 and 1 patients respectively. Of the patients who had an interim and end of treatment scan, 31% (6/19) had complete remission, 36% (7/19) had partial remission (PR), with an overall response rate of 66% (13/19). 66.6% (4/6)of patients who had treatmet to bridge to CAR T cells had 25% (1/4) had complete remission, 50% (2/4) had partial remission and 25% (1/4) had progressive disease following CAR T cell therapy
Conclusion
Rituximab, polatuzumab along with Bendamustine is an effective treatment strategy in patients with relapsed / refractory high grade lymphoma. More data are required to consider RBP as a salvage treatment, with or without consolidation autologous bone marrow transplant for ralpased DLBCL.
Keyword(s):
Abstract: EP555
Type: E-Poster Presentation
Session title: Aggressive Non-Hodgkin lymphoma - Clinical
Background
The combination chemotherapy incorporating polatuzumab along with rituximab and Bendamustine has shown a significant response in relapsed /refractory high grade lymphoma. .
Aims
To review the response of all patients who received rituximab, polatuzamab and bendamustine (RPB) for relapsed /refractory diffuse large B cell lymphoma (DLBCL) and transformed high grade lymphoma in 4 district general hospitals in the East Anglia Cancer Network.
Methods
Retrospective analysis of data from 4 district general hospitals which serves a population of 1.26 million. All patients who had combination chemotherapy of rituximab, polatuzumab and bendamustine as stand-alone treatment or for bridging to Chimeric Antigen Receptor T cell (CAR T) therapy were identified from from June 2019. Patients were given 1.8mg/kg of polatuzumab, 375mg/m2 of rituximab on day 1 and 90mg/m2 of Bendamustine on day 1 and day 2 in a three weekly cycle. Objective clinical and radiological responses were assessed using modified Lugano Classification on interim staging CT scan after 3 cycles of treatment and positron emission tomography (PET) scan at the end of treatment.
Results
A total of 24 patients were identified from four district general hospitals in the East of Anglia Cancer Network. The mean age is 70.6 years (range 27-87) with M:F ratio of 2:1. The median ECOG was 2. De novo cases constituted 66% (16/24) of the patients. 29.1% (7/24) of the patients had transformed low grade lymphoma – 5 from follicular lymphoma and 1 each from marginal zone lymphoma and chronic lymphocytic lymphoma). There was 1 patient with primary mediastinal B cell lymphoma. 62.5% (15/24) of the patients had stage IV disease and 20% (5/24) of the patients had stage III disease. 16% (4/24) of patients had bulky disease prior to RBP cytotoxic chemotherapy. 75% (18/24) of the patients had extranodal involvement ranging from 1-5 extranodal sites. Mean IPI of the study group was 2.83. 29% (7/24) had double expresser phenotype on immunohistochemistry with 1 case of double hit lymphoma. Mean number of lines of therapy before RBP was 1.73. Only one patient was exposed to Bendamustine prior to RBP. All patients has had rituximab combination as a line of prior therapy and 37% (9/24) of patients were refractory to RCHOP chemotherapy. 54% (13/24) of patients were refractory to one line of prior therapy. 62.5% (15/24) of patients had less than 12 months of remission before RBP therapy. None of the patients had CAR T, autologous or allogeneic bone marrow transplant prior to the therapy. 75% (18/24) patients had the treatment as a standalone treatment, while 25% (6/24) had RBP as a bridge to CAR T cell therapy. In the standalone group, the median number of cycles of RBP was 4.33 with infection and peripheral neuropathy manifested in 3 and 1 patients respectively. Of the patients who had an interim and end of treatment scan, 31% (6/19) had complete remission, 36% (7/19) had partial remission (PR), with an overall response rate of 66% (13/19). 66.6% (4/6)of patients who had treatmet to bridge to CAR T cells had 25% (1/4) had complete remission, 50% (2/4) had partial remission and 25% (1/4) had progressive disease following CAR T cell therapy
Conclusion
Rituximab, polatuzumab along with Bendamustine is an effective treatment strategy in patients with relapsed / refractory high grade lymphoma. More data are required to consider RBP as a salvage treatment, with or without consolidation autologous bone marrow transplant for ralpased DLBCL.
Keyword(s):