Rituximab,Dexamethasone, Cytarabine,and Oxaliplatin (R-DHAX) Is an Effective and Safe Salvage Regimen in Relapsed/Refractory B-Cell Non-Hodgkin Lymphoma |
| |
| Authors: | Julie Lignon David Sibon Isabelle Madelaine Pauline Brice Patricia Franchi Josette Briere Nicolas Mounier Christian Gisselbrecht Pierre Faure Catherine Thieblemont |
| |
| Institution: | 1. Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York;2. Hematologic Malignancies and Bone Marrow Transplantation Program, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland;3. Division of Clinical Research, Fred Hutchinson Cancer Research Center and Department of Medicine, University of Washington, Seattle, Washington;4. Department of Hematology and Oncology, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas;5. Lymphoma Program, Abramson Cancer Center at University of Pennsylvania, Philadelphia, Pennsylvania;6. Division of Hematology, Mayo Clinic, Rochester, Minnesota;7. Oncology Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia;8. Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, Texas;9. Division of Hematology and Medical Oncology, Vanderbilt University Medical Center, Nashville, Tennessee;10. The Chaim Sheba Medical Center, Tel-Hashomer, Affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel;11. Blood and Marrow Transplant and Cellular Immunotherapy Program, Moffitt Cancer Center, Tampa, Florida;12. Immune Effector Cell Therapy Program, Dana-Farber Cancer Institute, Boston, Massachusetts;13. National Marrow Donor Program and Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota;14. Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota;15. Center for Cancer and Immunology Research, Children''s National Health System, Washington, DC;16. Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington;17. Division of Oncology, Washington University School of Medicine, St Louis, Missouri;18. Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin;19. Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas;20. Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington;21. Division of Transplantation and Cellular Therapy, Sylvester Comprehensive Cancer Center, Miami, Florida;22. Department of General Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas;23. Division of Hematology and Oncology, Case Western Reserve University, Cleveland, Ohio;24. Department of Pediatrics, University of Texas Medical Branch, Galveston, Texas;25. Hematology and Cellular Therapy Department, Saint-Antoine Hospital, AP-HP, Sorbonne University, INSERM UMRs 938, Paris, France;26. Division of Blood and Marrow Transplantation, Stanford University, Stanford, California;27. Graft-versus-Host and Late Effects Section, National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, Maryland;28. Division of Hematology-Oncology and Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, Florida;29. Department of Medicine, Weill Cornell Medical College, New York, New York |
| |
| Abstract: | BackgroundSalvage 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.Patients and MethodsWe 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.ResultsGrade 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.ConclusionR-DHAX is an efficient regimen in patients with relapsed/refractory B-cell NHL even in elderly patients if hematologic toxicities are closely managed. |
| |
| Keywords: | |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
