Rituximab, dexamethasone, cytarabine, and oxaliplatin (R-DHAX) is an effective and safe salvage regimen in relapsed/refractory B-cell non-Hodgkin lymphoma.
ABSTRACT Salvage therapy for patients with refractory/relapsed B-cell non-Hodgkin lymphoma (NHL) is based on polychemotherapy, followed by high-dose therapy and autologous stem cell transplantation in eligible patients (HDT/ASCT). R-DHAP combines rituximab with cisplatin, cytarabine, and dexamethasone.
We substituted cisplatin with oxaliplatin to avoid nephrotoxicity and retrospectively analyzed a large series of 91 patients with refractory/relapsed B-cell NHL to evaluate toxicities, response rates (RRs), and survival. Median age at R-DHAX (rituximab/dexamethasone/cytarabine/oxaliplatin) treatment was 60 years (range, 28-82 years). Renal insufficiency was present in 18 patients. The most frequent histologic subtypes were diffuse large B-cell lymphoma (n = 42) and follicular lymphoma (n = 30). Seventeen patients (19%) were naive to rituximab at time of R-DHAX.
Grade III/IV toxicities were mainly hematologic, including anemia (n = 9), neutropenia (n = 44), and thrombocytopenia (n = 47). Grade I/II neurologic toxicities, sensitive or motor, were observed, and these were mainly transient except for 3 cases of motor neuropathy associated with previous exposure to vincristine. Neither renal toxicities nor degradation of previous renal insufficiency were observed. The overall RR was 75%, with a complete RR of 57%, with no statistical difference between patients previously treated with rituximab versus without rituximab. At a median follow-up of 23 months, 2-year probability rates of overall survival and progression-free survival were 75% and 43%, respectively, with a significant difference between patients treated with HDT/ASCT and patients not eligible for HDT/ASCT.
R-DHAX is an efficient regimen in patients with relapsed/refractory B-cell NHL even in elderly patients if hematologic toxicities are closely managed.
- Blood 07/2013; 122(4):469-70. · 9.78 Impact Factor
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ABSTRACT: A previous pilot study with rituximab, gemcitabine and oxaliplatin has shown promising activity in refractory/relapsed B-cell lymphoma. Therefore, we conducted a phase II study, in order to determine whether these results could be reproduced in a multi-institutional setting. This phase II study includes 49 patients with refractory (n=6) /relapsing (n=43) diffuse large B-cell lymphoma. Patients had a median age of 69 years. Prior treatment included rituximab in 31 (63%) and autologous transplant in 17 (35%) patients. International Prognostic Index at enrolment was > 2 in 34 patients (71%). Primary objective was overall response rate after 4 cycles. Patients were planned to receive 8 cycles given in case if they reached partial remission after 4 cycles. After 4 cycles, responses were: complete remission 21 (44%), partial remission 8 (17%) resulting in an overall response rate of 61 %. Factors significantly affecting overall response rate were: early (< 1year) progression/relapse 18% vs 54% (p=0.001) and prior exposure to rituximab 23% vs 65% (p=0.004). Five-year Progression-Free and Overall Survival were 12.8% and 13.9%, respectively. Rituximab, gemcitabine and oxaliplatin was well tolerated with grade 3-4 infectious episodes in 22% of the cycles. These results are the first confirmation by a multi-institution study that Rituximab, gemcitabine and oxaliplatin provides a consistent response rate in refractory/relapsed patients. It can now be considered as a platform for new combinations with targeted treatments. This trial was registered at clinicaltrial.gov under #NCT00169195. The results were partly presented in an oral session at the American Society of Hematology annual meeting in Chicago, USA, in December 2010.Haematologica 06/2013; · 5.94 Impact Factor
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ABSTRACT: Relapsed-Refractory Diffuse Large B Cell Lymphoma (RR DLBCL), which accounts for approximately one-third of patients with DLBCL, remains a major cause of morbidity and mortality. Managing RR DLBCL continues to be a challenge to the treating hemato-oncologist. Salvage high-dose chemotherapy followed by autologous stem cell transplantation is the standard of care for chemosensitive relapses in DLBCL. Various salvage regimens are available, but the quest for an optimal regimen continues. The addition of rituximab to the salvage regimen has improved the outcome of RR DLBCL. Several pertinent issues regarding the management of RR DLBCL are discussed in this short review.South Asian journal of cancer. 01/2014; 3(1):66-70.