Rituximab, Ara-C, dexamethasone and oxaliplatin is safe and active in heavily pretreated patients with diffuse large B-cell lymphoma.
OBJECTIVE
Patients with relapsed diffuse large B-cell lymphoma (DLBCL) who are either not suitable for stem cell transplantation or suffer from relapsed disease after standard second-line chemotherapy face a dismal prognosis. Most of them have a reduced performance status and do not tolerate intensive chemotherapy.


METHODS
Twenty patients with relapsed DLBCL were given rituximab 375 mg/m(2) intravenously on day 1, Ara-C 2 x 1,000 mg intravenously on day 2, dexamethasone 40 mg intravenously on days 1-4, and oxaliplatin 130 mg/m(2) intravenously over 2 h on day 3 (R-ADOx).


RESULTS
Five patients (25%) achieved a complete remission, 9 (45%) had a partial response , 2 (10%) had stable disease with improvement in performance status, while 4 patients (20%) progressed. The median survival was 11 months (range 1-13). Despite extensive pretreatment, side effects were relatively mild and consisted of thrombocytopenia WHO grade III in 9 (45%) and grade IV in 2 (11%) patients, leukocytopenia WHO grade III in 10 (50%) cases (with infectious episodes in 2 patients), and transient peripheral neuropathy in 9 (45%) patients.


CONCLUSIONS
R-ADOx is well tolerated in heavily pretreated patients with an impaired performance status. In addition, it displays impressive therapeutic activity given the highly unfavorable patient characteristics and should be further investigated for treatment of DLBCL.
Woehrer
Stefan
S
Division of Bone Marrow Transplantation, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria.
Hejna
Michael
M
Skrabs
Cathrin
C
Drach
Johannes
J
Zielinski
Christoph C
CC
Jaeger
Ulrich
U
Raderer
Markus
M
D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D058846:Antibodies, Monoclonal, Murine-Derived; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D003561:Cytarabine / Q000008:administration & dosage; D003907:Dexamethasone / Q000008:administration & dosage; D005260:Female; D006801:Humans; D016393:Lymphoma, B-Cell / Q000188:drug therapy*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D012189:Retrospective Studies; D000069283:Rituximab; D016019:Survival Analysis; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000964:Antimetabolites, Antineoplastic; D009944:Organoplatinum Compounds; D003561:Cytarabine; D000077150:Oxaliplatin; D000069283:Rituximab; D003907:Dexamethasone