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Addition of lenalidomide to rituximab, ifosfamide, carboplatin, etoposide ( RICER ) in first‐relapse/primary refractory diffuse large B‐cell lymphoma
Author(s) -
Feldman Tatyana,
Mato Anthony R.,
Chow Kar F.,
Protomastro Ewelina A.,
Yannotti Kara M. L.,
Bhattacharyya Pritish,
Yang Xiao,
Donato Michele L.,
Rowley Scott D.,
Carini Carolanne,
Valentinetti Marisa,
Smith Judith,
Gadaleta Gabriella,
Bejot Coleen,
Stives Susan,
Timberg Mary,
Kdiry Sabrina,
Pecora Andrew L.,
Beaven Anne W.,
Goy Andre
Publication year - 2014
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.12846
Subject(s) - lenalidomide , medicine , carboplatin , etoposide , ifosfamide , autologous stem cell transplantation , oncology , thalidomide , diffuse large b cell lymphoma , surgery , rituximab , regimen , multiple myeloma , salvage therapy , chemotherapy , lymphoma , cisplatin
Summary Relapsed/refractory diffuse large B‐cell lymphoma ( DLBCL ) is associated with a poor prognosis. Outcomes are particularly poor following immunochemotherapy failure or relapse within 12 months of induction. We conducted a Phase I/II trial of lenalidomide plus RICE (rituximab, ifosfamide, carboplatin, and etoposide) ( RICER ) as a salvage regimen for first‐relapse or primary refractory DLBCL . Dose‐escalated lenalidomide was combined with RICE every 14 d. After three cycles of RICER , patients with chemosensitive disease underwent stem cell collection and consolidation with BEAM [ BCNU (carmustine), etoposide, cytarabine, melphalan] followed by autologous stem cell transplantation (auto SCT ). Patients who recovered from auto SCT toxicities within 90 d initiated maintenance treatment with lenalidomide 25 mg daily for 21 d every 28 d for 12 months. No dose‐limiting or unexpected toxicities occurred with lenalidomide 25 mg plus RICE . Grade 3/4 haematological toxicities resolved appropriately, and planned dose density and dose intensity of RICER were preserved. No lenalidomide or RICE dose reductions were required in any of the three cycles. After two cycles of RICER , nine of 15 patients (60%) achieved a complete response, and two achieved a partial response (13%). Combining lenalidomide with RICE is feasible, and results in promising response rates (particularly complete response rates) in high‐risk DLBCL patients.