title: Paclitaxel, topotecan and rituximab: long term outcomes of an effective salvage programme for relapsed or refractory aggressive B-cell non-Hodgkin lymphoma.
abstract: Relapsed aggressive lymphomas are often treated with platinum-based chemotherapy (PBC) followed by an autologous stem cell transplant (ASCT). Response rates to PBC in patients with relapsed aggressive lymphomas are c. 60%, and non-responders have a dismal prognosis. Novel therapies for aggressive lymphomas, including those failing PBC, are needed. We performed a phase II study of paclitaxel, topotecan and rituximab (TTR) in patients with relapsed or refractory diffuse large B-cell, follicular grade IIIB, or transformed lymphomas, including those who previously failed PBC. The median age of the 72 patients enrolled was 54 years. Responding patients were offered ASCT after two courses. The overall response rate was 69% for all patients (n = 49/71) and 45% for those who previously failed PBC (n = 9/20). With a median follow up of 125 months for the censored observations, the overall survival (OS) and progression-free survival at 5 years was 39% and 27%, respectively. Responding patients who received ASCT had an OS of 63% at 5 years. Our results demonstrate that TTR is an effective salvage regimen for patients with relapsed aggressive B-cell lymphomas, including those who previously failed PBC. Given the declining therapeutic outcomes of salvage PBC in the rituximab era, further evaluation of TTR is warranted.
authors.affiliation: Department of Lymphoma and Myeloma, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
authors.forename: Jason R
authors.initials: JR
authors.lastname: Westin
authors.forename: Peter
authors.initials: P
authors.lastname: McLaughlin
authors.forename: Jorge
authors.initials: J
authors.lastname: Romaguera
authors.forename: Fredrick B
authors.initials: FB
authors.lastname: Hagemeister
authors.forename: Barbara
authors.initials: B
authors.lastname: Pro
authors.forename: Nam H
authors.initials: NH
authors.lastname: Dang
authors.forename: Felipe
authors.initials: F
authors.lastname: Samaniego
authors.forename: Maria A
authors.initials: MA
authors.lastname: Rodriguez
authors.forename: Luis
authors.initials: L
authors.lastname: Fayad
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Oki
authors.forename: Michelle
authors.initials: M
authors.lastname: Fanale
authors.forename: Nathan
authors.initials: N
authors.lastname: Fowler
authors.forename: Loretta
authors.initials: L
authors.lastname: Nastoupil
authors.forename: Lei
authors.initials: L
authors.lastname: Feng
authors.forename: Evelyn
authors.initials: E
authors.lastname: Loyer
authors.forename: Anas
authors.initials: A
authors.lastname: Younes
mesh_terms: D000293:Adolescent; 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*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016393:Lymphoma, B-Cell / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage / Q000009:adverse effects; D012008:Recurrence; D000069283:Rituximab; D016879:Salvage Therapy / Q000009:adverse effects / Q000379:methods; D016019:Survival Analysis; D019772:Topotecan / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D019772:Topotecan; D017239:Paclitaxel
keywords: chemotherapy; clinical trial; non-Hodgkin lymphoma; paclitaxel; topotecan