title: Addition of lenalidomide to rituximab, ifosfamide, carboplatin, etoposide (RICER) in first-relapse/primary refractory diffuse large B-cell lymphoma.
abstract: 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 (autoSCT). Patients who recovered from autoSCT 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.
authors.affiliation: John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA.
authors.forename: Tatyana
authors.initials: T
authors.lastname: Feldman
authors.forename: Anthony R
authors.initials: AR
authors.lastname: Mato
authors.forename: Kar F
authors.initials: KF
authors.lastname: Chow
authors.forename: Ewelina A
authors.initials: EA
authors.lastname: Protomastro
authors.forename: Kara M L
authors.initials: KM
authors.lastname: Yannotti
authors.forename: Pritish
authors.initials: P
authors.lastname: Bhattacharyya
authors.forename: Xiao
authors.initials: X
authors.lastname: Yang
authors.forename: Michele L
authors.initials: ML
authors.lastname: Donato
authors.forename: Scott D
authors.initials: SD
authors.lastname: Rowley
authors.forename: Carolanne
authors.initials: C
authors.lastname: Carini
authors.forename: Marisa
authors.initials: M
authors.lastname: Valentinetti
authors.forename: Judith
authors.initials: J
authors.lastname: Smith
authors.forename: Gabriella
authors.initials: G
authors.lastname: Gadaleta
authors.forename: Coleen
authors.initials: C
authors.lastname: Bejot
authors.forename: Susan
authors.initials: S
authors.lastname: Stives
authors.forename: Mary
authors.initials: M
authors.lastname: Timberg
authors.forename: Sabrina
authors.initials: S
authors.lastname: Kdiry
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Pecora
authors.forename: Anne W
authors.initials: AW
authors.lastname: Beaven
authors.forename: Andre
authors.initials: A
authors.lastname: Goy
mesh_terms: D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage / Q000009:adverse effects; D000077269:Lenalidomide; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012008:Recurrence; D000069283:Rituximab; D016879:Salvage Therapy / Q000009:adverse effects / Q000379:methods; D013792:Thalidomide / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D016896:Treatment Outcome
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D013792:Thalidomide; D005047:Etoposide; D016190:Carboplatin; D000077269:Lenalidomide; D007069:Ifosfamide
keywords: bone marrow transplantation; diffuse large B-cell lymphoma; lenalidomide; rituximab; salvage