Rituximab–EPOCH, an effective salvage therapy for relapsed, refractory or transformed B-cell lymphomas: results of a phase II study

Abstract

The rituximab-EPOCH regimen is effective and well tolerated, even in extensively pretreated patients with relapsed or refractory large B-cell lymphoma and mantle-cell lymphoma.

R-ESHAP as salvage therapy for patients with relapsed or refractory diffuse large B-cell lymphoma: the influence of prior exposure to rituximab on outcome. A GEL/TAMO study

“…In 225 evaluable patients, the addition of rituximab to second-line chemotherapy resulted in a significant improvement of overall response rate (75% versus 54%, p=0.01) and progression-free survival (52% versus 31% at 2 years, p<0.002). 12 Other small phase 2 trials (with a range of 35-55 patients) investigating rituximab in combination with ICE, 13 DHAP 14 or EPOCH 15 have also shown encouraging results. However, the patients in these studies had not been previously exposed to rituximab, while at present, almost all patients with aggressive B-cell nonHodgkin's lymphoma receive rituximab combined with first-line chemotherapy.…”

Prolonged myelosuppression with clofarabine in the treatment of patients with relapsed or refractory, aggressive non-Hodgkin lymphoma

“…Although Grade 3-4 myelosuppression is expected with standard salvage therapy in patients with relapsed or refractory DLCL [4][5][6][7][8], persistent Grade 3-4 thrombocytopenia for a median of 77 days is uncommon without evidence of bone marrow involvement. This prolonged myelosuppression with clofarabine in the treatment of NHL also contrasts with experience in adult acute leukemia where hematologic recovery typically occurs within 30 days [18].…”

“…Second or thirdline chemotherapy regimens [4][5][6][7][8] produce complete response (CR) rates of 25-50% in patients with chemosensitive relapse, and 15-30% in those with chemotherapy refractory disease. Identification of new therapeutic agents for patients with relapsed diffuse large cell lymphoma is therefore needed.…”

Durable remission of large B-cell lymphoma transformed from lymphoplasmacytic lymphoma/Waldenström macroglobulinemia successfully treated with sequential immunochemotherapy followed by reduced-intensity allogeneic stem cell transplantation

“…G-banded cytogenetic analysis showed a normal karyotype. She was diagnosed with transformed DLBCL from LPL/WM and treated with three courses of EPOCH chemotherapy combined with rituximab (R-EPOCH), 5 resulting in a reduction of LDH (141 IU/l) and IgM (4.68 g/l). Computed tomography scans showed no abnormalities.…”

“…R-EPOCH has proven activity as salvage therapy, 7,8 and was effective and well tolerated in heavily pretreated patients with relapsed/refractory DLBCL (including transformed type) and mantle-cell lymphoma. 5 For patients with advanced malignancy, unmanipulated allo-SCT from related donors other than HLA-matched siblings has been reported to be a reasonable alternative when a more suitable stem-cell source is not available. 9,10 Taken together, we considered that intensive R-EPOCH chemotherapy alone could not control LPL/ WM in transformation and chose to perform RICT from a partially mismatched related donor as post-remission therapy.…”