title: Bortezomib in combination with rituximab, dexamethasone, ifosfamide, cisplatin and etoposide chemoimmunotherapy in patients with relapsed and primary refractory diffuse large B-cell lymphoma.
abstract: Patients with relapsed or refractory diffuse large B-cell lymphoma may experience extended survival with second-line chemotherapy and autologous stem cell transplant (ASCT). Since a major determinant of outcome after ASCT is responsiveness to second-line therapy, the development of more effective second-line treatments is desirable. We investigated the addition of bortezomib to rituximab, dexamethasone, ifosfamide, cisplatin and etoposide (VIPER). Fifteen patients were enrolled, of whom seven were refractory to first-line chemotherapy and only three had maintained first response for 1 year. Nine (60%) patients achieved objective responses, of which three (20%) were IWC-PET (International Workshop Criteria positron emission tomography) complete responses. Median progression-free survival was 3 months, and median overall survival was 10 months. At a median follow-up of 26 months, five patients (33%) remained alive. Treatment was well tolerated with no unexpected toxicity. Although response rates did not meet predefined criteria, activity was at least comparable to other second-line approaches despite a poor-prognosis patient population.
authors.affiliation: Center for Lymphoma and Myeloma, Weill Cornell Medical College, New York, NY 10065, USA.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Elstrom
authors.forename: Biree
authors.initials: B
authors.lastname: Andemariam
authors.forename: Peter
authors.initials: P
authors.lastname: Martin
authors.forename: Jia
authors.initials: J
authors.lastname: Ruan
authors.forename: Tsiporah B
authors.initials: TB
authors.lastname: Shore
authors.forename: Morton
authors.initials: M
authors.lastname: Coleman
authors.forename: John P
authors.initials: JP
authors.lastname: Leonard
authors.forename: Richard R
authors.initials: RR
authors.lastname: Furman
mesh_terms: D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001897:Boronic Acids / Q000008:administration & dosage*; D000069286:Bortezomib; D002945:Cisplatin / Q000008:administration & dosage*; D003131:Combined Modality Therapy / Q000379:methods; D003907:Dexamethasone / Q000008:administration & dosage*; D018572:Disease-Free Survival; D005047:Etoposide / Q000008:administration & dosage*; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage*; D007167:Immunotherapy / Q000379:methods*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy*; D008875:Middle Aged; D046988:Proteasome Endopeptidase Complex / Q000378:metabolism; D011719:Pyrazines / Q000008:administration & dosage*; D012008:Recurrence; D000069283:Rituximab; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D001897:Boronic Acids; D011719:Pyrazines; D000069283:Rituximab; D000069286:Bortezomib; D005047:Etoposide; D003907:Dexamethasone; D046988:Proteasome Endopeptidase Complex; D002945:Cisplatin; D007069:Ifosfamide