title: Rituximab and ICE as second-line therapy before autologous stem cell transplantation for relapsed or primary refractory diffuse large B-cell lymphoma.
abstract: Patients with relapsed or primary refractory diffuse large B-cell lymphoma (DLBCL) who achieve complete response (CR) before autologous stem cell transplantation (ASCT) generally have better outcomes than those who achieve only partial response (PR). We investigated whether adding rituximab to the ifosfamide-carboplatin-etoposide (ICE) chemotherapy regimen (RICE) could increase the CR rate of patients with DLBCL under consideration for ASCT. Thirty-six eligible patients were treated with RICE, and 34 received all 3 planned cycles. The CR rate was 53%, significantly better than the 27% CR rate (P =.01) achieved among 147 similar consecutive historical control patients with DLBCL treated with ICE; the PR rate was 25%. Febrile neutropenia was the most frequent grade 3 or 4 nonhematologic toxicity; it occurred in 7.5% of delivered cycles. No patient had RICE-related toxicity that precluded ASCT. The median number of CD34(+) cells per kilogram mobilized was 6.3 x 10(6). Progression-free survival rates of patients who underwent transplantation after RICE were marginally better than those of 95 consecutive historical control patients who underwent transplantation after ICE (54% vs 43% at 2 years; P =.25). RICE appears to induce very high CR rates in patients with relapsed and refractory DLBCL; however, further studies are necessary to determine whether this treatment regimen will improve outcomes after ASCT.
authors.affiliation: Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. kewalrat@mskcc.org
authors.forename: Tarun
authors.initials: T
authors.lastname: Kewalramani
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Zelenetz
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Nimer
authors.forename: Carol
authors.initials: C
authors.lastname: Portlock
authors.forename: David
authors.initials: D
authors.lastname: Straus
authors.forename: Ariela
authors.initials: A
authors.lastname: Noy
authors.forename: Owen
authors.initials: O
authors.lastname: O'Connor
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Filippa
authors.forename: Julie
authors.initials: J
authors.lastname: Teruya-Feldstein
authors.forename: Alison
authors.initials: A
authors.lastname: Gencarelli
authors.forename: Jing
authors.initials: J
authors.lastname: Qin
authors.forename: Alyson
authors.initials: A
authors.lastname: Waxman
authors.forename: Joachim
authors.initials: J
authors.lastname: Yahalom
authors.forename: Craig H
authors.initials: CH
authors.lastname: Moskowitz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000633:toxicity; D058846:Antibodies, Monoclonal, Murine-Derived; D018952:Antigens, CD34 / Q000032:analysis; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use* / Q000633:toxicity; D016190:Carboplatin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D016393:Lymphoma, B-Cell / Q000150:complications / Q000401:mortality / Q000628:therapy*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced; D012074:Remission Induction / Q000379:methods; D000069283:Rituximab; D016879:Salvage Therapy / Q000379:methods; D016019:Survival Analysis; D014182:Transplantation, Autologous
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018952:Antigens, CD34; D000069283:Rituximab; D005047:Etoposide; D016190:Carboplatin; D007069:Ifosfamide