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First-line Treatment With Bendamustine and Rituximab for Old and Frail Patients With Aggressive Lymphoma: Results of the B-R-ENDA Trial. Hemasphere 2022; 6:e808. [PMID: 36479544 PMCID: PMC9722574 DOI: 10.1097/hs9.0000000000000808] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/31/2022] [Indexed: 01/24/2023] Open
Abstract
The incidence of aggressive B-cell lymphomas increases with age, but for elderly or frail patients not eligible for doxorubicin-containing treatment standard therapy remains to be defined. In this prospective, multicenter, phase-2 B-R-ENDA trial, we investigated the feasibility, toxicity, and efficacy of 8 cycles rituximab combined with 6 cycles bendamustine (BR) in elderly or frail aggressive B-cell lymphoma patients: 39 patients aged >80 years and 29 patients aged 61-80 years with elevated Cumulative Illness Rating Scalescore >6 were included. Progression-free survival (PFS) and overall survival (OS) at 2 years were 45% (95% confidence interval [CI], 28%-61%) and 46% (28%-63%) for the patients age >80, as well 32% (13%-51%) and 37% (17%-57%) for frail patients age 64-80, respectively. In a preplanned retrospective analysis, we found no significant differences in PFS and OS comparing the outcome of the 39 patients age >80 years with 40 patients aged 76-80 years treated with 6xR-CHOP (cyclophosphamide, doxorubicin, vincristine, prednisolone) and 2 x rituximab in the RICOVER-60 trial (DSHNHL 1999-1, NCT00052936, EU-20243), yet we detected lower rates of infections and treatment-related deaths in the BR-treated patients. We demonstrate that older and frail patients with aggressive B-cell lymphoma who are not able to receive standard CHOP-based therapy can benefit from anthracycline-free therapy as a feasible and effective therapeutic option.
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Karadurmus N, Paydas S, Esin E, Surmeli ZG, Yildiz B, Erturk I, Nayir E, Dogan M, Sumbul AT, Barista I, Gurkan E, Ocal R, Ferhanoglu B, Ozgur G, Karakas Y, Lacin S, Ozaydin S, Petekkaya HI, Uskent N. Effectiveness of bendamustine in relapsed or refractory lymphoma cases: a Turkish Oncology Group study. Arch Med Sci 2021; 17:920-927. [PMID: 34336021 PMCID: PMC8314394 DOI: 10.5114/aoms.2019.83000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 08/07/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION We aimed to investigate the efficacy and side effects of bendamustine in relapsed/refractory lymphoma patients in Turkey. MATERIAL AND METHODS In this retrospective study, we included relapsed/refractory Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) patients who underwent multiple lines of chemotherapy. The primary endpoint was to determine the objective response and toxicity. RESULTS Ninety-nine patients with a median age of 59.8 years were included in the study. Eighty-one patients had NHL (follicular lymphoma: 10, diffuse large B-cell lymphoma: 27, mantle-cell lymphoma: 18, marginal zone lymphoma: 9, small lymphocytic lymphoma/chronic lymphocytic leukemia: 17) and 18 patients had HL. The patients had previously received a median of three lines of chemotherapy (range: 2-8) except autologous stem cell transplantation (ASCT); 19 patients (HL: 11, NHL: 8) had undergone ASCT. The objective response rate (ORR) was 74.3%, the complete response rate was 57% (= 53), and the partial response rate was 16.6% ( = 19). The overall survival (OS) rate at 1 year was 74.6%. The progression-free survival (PFS) rate at 1 year was 62.5%. The most common side effects were lymphopenia, anemia and neutropenia. Side effects which were observed as grade 3 and higher levels were lymphopenia (14.1%), neutropenia (10.1%) and fatigue (7.1%). CONCLUSIONS Objective response rate of bendamustine was found to be 74.3% in relapsed/refractory HL and NHL patients. It appears to be an effective option as a salvage treatment for patients who have previously received multiple lines of therapy.
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Affiliation(s)
- Nuri Karadurmus
- Department of Medical Oncology, Health Sciences University, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Semra Paydas
- Department of Medical Oncology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Ece Esin
- Department of Medical Oncology, Health Sciences University, Dr. Abdurrahman Yurtaslan Training and Research Hospital, Ankara, Turkey
| | | | - Birol Yildiz
- Department of Medical Oncology, Health Sciences University, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Ismail Erturk
- Department of Medical Oncology, Health Sciences University, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Erdinc Nayir
- Department of Medical Oncology, Medicalpark Hospital, Ankara, Turkey
| | - Mutlu Dogan
- Department of Medical Oncology, Health Sciences University, Numune Training and Research Hospital, Ankara, Turkey
| | - Ahmet Taner Sumbul
- Department of Medical Oncology, Faculty of Medicine, Baskent University, Adana, Turkey
| | - Ibrahim Barista
- Department of Medical Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Emel Gurkan
- Department of Haematology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Ramazan Ocal
- Department of Haematology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Burhan Ferhanoglu
- Department of Haematology, Faculty of Medicine, Koc University, Istanbul, Turkey
| | - Gokhan Ozgur
- Department of Haematology, Health Sciences University, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Yusuf Karakas
- Department of Medical Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sahin Lacin
- Department of Medical Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sukru Ozaydin
- Department of Medical Oncology, Health Sciences University, Gulhane Training and Research Hospital, Ankara, Turkey
| | | | - Necdet Uskent
- Department of Medical Oncology, Anatolian Health Center, Istanbul, Turkey
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3
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Prusila REI, Peroja P, Jantunen E, Turpeenniemi-Hujanen T, Kuittinen O. Treatment of diffuse large B-cell lymphoma in elderly patients: Replacing doxorubicin with either epirubicin or etoposide (VP-16). Hematol Oncol 2019; 37:136-142. [PMID: 30589950 DOI: 10.1002/hon.2572] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/07/2018] [Accepted: 12/21/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Roosa Enni Inkeri Prusila
- Cancer and Translational Medicine Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Department of Oncology and Radiotherapy, Oulu University Hospital, Oulu, Finland
| | - Pekka Peroja
- Cancer and Translational Medicine Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Department of Oncology and Radiotherapy, Oulu University Hospital, Oulu, Finland
| | - Esa Jantunen
- Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Medicine, Kuopio University Hospital, Kuopio, Finland.,Siunsote - Hospital District of North Carelia, Joensuu, Finland
| | - Taina Turpeenniemi-Hujanen
- Cancer and Translational Medicine Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Department of Oncology and Radiotherapy, Oulu University Hospital, Oulu, Finland
| | - Outi Kuittinen
- Department of Oncology and Radiotherapy, Oulu University Hospital, Oulu, Finland.,Faculty of Health Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Oncology, Kuopio University Hospital, Kuopio, Finland
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4
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Schelker RC, Herr W, Reichle A, Vogelhuber M. Low-dose trofosfamide plus rituximab is an effective and safe treatment for diffuse large B-cell lymphoma of the elderly: a single center experience. BMC Cancer 2018; 18:1000. [PMID: 30340554 PMCID: PMC6195694 DOI: 10.1186/s12885-018-4885-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 10/01/2018] [Indexed: 02/03/2023] Open
Abstract
Background Rituximab plus combination chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is broadly accepted as standard for the treatment of diffuse large B-cell lymphoma (DLBCL). Nevertheless, there is sparsely data concerning the management of elderly patients. Methods We performed a retrospective study of treatment with rituximab and low-dose trofosfamide in elderly patients (≥ 75 years) with DLBCL who were not suitable for R-CHOP or R-CHOP-like regimens or who did not consent to aggressive treatment. The choice regarding the qualification for R-CHOP or R-CHOP-like regimen was left to the estimation of the treating physicians. Results Eleven patients with a median age of 83 years (range, 75–90 years) were included. The age-adjusted international prognostic index was low risk in one patient, low-intermediate in four patients, high-intermediate in three patients, and high risk in 3 patients. All patients were evaluable for response. Five patients (45%) achieved a complete response, three (27%) a partial response, one (9%) stable disease, and two (18%) progressive disease. The estimated 1-yr overall survival was 54.5%, and the estimated 1-yr progression-free survival 45.5%, however, three patients (27%) were alive without evidence of disease at 16–20 months from start of treatment. Main toxicity was leukopenia (36% grade III or IV), whereas grade III/IV non-hematological adverse events did not occur. Conclusions Due to its potency and low toxicity, trofosfamide/rituximab might represent an alternative therapy for DLBCL of elderly patients not suitable for R-CHOP. This observation, however, should be confirmed in a larger patient population within a prospective clinical trial.
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Affiliation(s)
- Roland Christian Schelker
- Department of Internal Medicine III, Hematology & Oncology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
| | - Wolfgang Herr
- Department of Internal Medicine III, Hematology & Oncology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Albrecht Reichle
- Department of Internal Medicine III, Hematology & Oncology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Martin Vogelhuber
- Department of Internal Medicine III, Hematology & Oncology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
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5
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Cheng CL, Liu JH, Chou SC, Yao M, Tang JL, Tien HF. Retrospective analysis of frontline treatment efficacy in elderly patients with diffuse large B-cell lymphoma. Eur J Haematol 2018; 101:28-37. [PMID: 29603428 DOI: 10.1111/ejh.13069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate the effectiveness of 2 chemotherapeutic regimens, bendamustine plus rituximab (BR) or reduced-dose cyclophosphamide, doxorubicin, vincristine, and prednisone plus rituximab (RD-R-CHOP), in elderly patients with treatment-naïve diffuse large B-cell lymphoma. METHODS A retrospective study was conducted to investigate the efficacy and safety of 2 frontline regimens, BR and RD-R-CHOP, in patients aged ≥75 years unfit for R-CHOP. RESULTS From January 2011 to December 2015, 26 patients received BR and 34 RD-R-CHOP. No significant difference was found in clinical background comparisons. The overall response rate was 50% and 79.4% for BR and RD-R-CHOP, respectively (P = .027). Compared with patients in RD-R-CHOP, those in BR had a lower complete remission rate (42.3% vs 70.6%, P = .036), higher progressive disease rate (38.5% vs 8.8%, P = .01), and poorer median overall survival (11.2 months vs 39 months, P = .035). The prognostic difference was mainly observed in patients with limited stage. By contrast, BR had better toxic profiles. Some patients in BR certainly showed long-term survivals. CONCLUSIONS This study demonstrated better efficacy of RD-R-CHOP, indicating its administration might be considered whenever possible, especially for limited stage. However, BR is a reasonable alternative for those ineligible for anthracycline-containing regimens. Further studies are needed to guide treatment decisions.
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Affiliation(s)
- Chieh-Lung Cheng
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei City, Taiwan.,Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Jia-Hau Liu
- Taicheng Stem Cell Therapy Center, National Taiwan University, Taipei City, Taiwan
| | - Sheng-Chieh Chou
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Ming Yao
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Jih-Luh Tang
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Hwei-Fang Tien
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei City, Taiwan
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Liao SH, Chen YK, Yu SC, Wu MS, Wang HP, Tseng PH. An unusual case of primary hepatic lymphoma with dramatic but unsustained response to bendamustine plus rituximab and literature review. SAGE Open Med Case Rep 2017; 5:2050313X17709190. [PMID: 28596829 PMCID: PMC5448865 DOI: 10.1177/2050313x17709190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 04/17/2017] [Indexed: 12/18/2022] Open
Abstract
Objectives: Primary hepatic lymphoma is an uncommon cause of hepatic space-occupying lesions. Methods: We describe the case of a 73-year-old man with primary hepatic lymphoma, who presented with a low-grade fever and lower limb weakness which had progressed in the past 2 months. Results: Abdominal ultrasound and computed tomography showed multiple small hepatic tumors. Echo-guided biopsy of the hepatic tumor demonstrated primary hepatic diffuse large B cell lymphoma. Moreover, bone marrow was uninvolved, but the bone marrow smear disclosed hemophagocytosis, which is uncommon in diffuse large B cell lymphoma. Chemotherapy with bendamustine and rituximab treatment was initiated with a dramatic response: hepatic tumors markedly shrank in size shown by follow-up computed tomography and the patient returned to his normal life. Nevertheless, the response was sustained for only 8 months. Finally, the disease resisted further chemotherapy and this patient died of a severe Klebsiella pneumoniae infection. Conclusion: Chemotherapy with bendamustine and rituximab has shown a dramatic, but not durable, response in the present case with old age and multiple comorbidities.
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Affiliation(s)
- Sih-Han Liao
- National Taiwan University Cancer Center, Taipei, Taiwan
| | - Yin-Kai Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shan-Chi Yu
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Shiang Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ping-Huei Tseng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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7
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Chiappella A, Castellino A, Nicolosi M, Santambrogio E, Vitolo U. Diffuse Large B-cell Lymphoma in the elderly: standard treatment and new perspectives. Expert Rev Hematol 2017; 10:289-297. [PMID: 28290728 DOI: 10.1080/17474086.2017.1305264] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Diffuse large B-cell lymphoma (DLBCL) is the most common histotype in non Hodgkin lymphoma, with a peak incidence in the sixth decade. The standard treatment for elderly FIT DLBCL patients is Rituximab-CHOP; in unfit and frail patients, chemotherapy at reduced intensity should be considered. Areas covered: In this article, we will review use of standard therapies and new drugs investigated such as immonomudulating agents (IMiDs), Bruton Tyrosine Kinase (BTK), in fit, unfit, frail and very elderly DLCBL patients. Expert commentary: R-CHOP21 in fit DLBCL patients is still the standard of care, while in elderly unfit patients a reduction of doses of cytotoxic drugs or schemes that avoid antracycline should be considered. The Comprensive Geriatric Assesment based in age, comorbidities and functional abilities of daily living is an important tool in elderly, in order to discriminate between fit, unfit or frail patients. Novel drugs represent valid therapeutic options in relapsed/refractory setting so continued participation in clinical trials should be encouraged.
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Affiliation(s)
- Annalisa Chiappella
- a Hematology , Città della Salute e della Scienza Hospital and University , Turin , Italy
| | - Alessia Castellino
- a Hematology , Città della Salute e della Scienza Hospital and University , Turin , Italy
| | - Maura Nicolosi
- a Hematology , Città della Salute e della Scienza Hospital and University , Turin , Italy
| | - Elisa Santambrogio
- a Hematology , Città della Salute e della Scienza Hospital and University , Turin , Italy
| | - Umberto Vitolo
- a Hematology , Città della Salute e della Scienza Hospital and University , Turin , Italy
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8
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Alrifai T, Grant Szymanski K, Venugopal P, Mahon B, Okwuosa T, Karmali R. Bendamustine and Rituximab: Complete Response in a 62-Year-Old Female with an Aggressive Lymphoma and an Ejection Fraction of 20. Chemotherapy 2016; 62:140-146. [PMID: 27960150 DOI: 10.1159/000452756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 10/18/2016] [Indexed: 11/19/2022]
Abstract
The treatment of diffuse large B-cell lymphoma in the presence of cardiac comorbidities can be challenging considering that the standard treatment regimen used for this aggressive subtype of non-Hodgkin lymphoma (NHL) consists of a combination of rituximab, cyclophosphamide, doxorubicin hydrochloride, Oncovin (vincristine), and prednisone (R-CHOP). The use of the anthracycline doxorubicin has been associated with arrhythmias and cardiomyopathy, making patients with cardiac dysfunction poor candidates for R-CHOP. As such, it is imperative to find alternative regimens that omit cardiac toxicity without compromising efficacy for this patient population. We report a case of composite NHL in a patient who received frontline bendamustine with rituximab with encouraging results. Our patient had a left ventricular ejection fraction of 20%, making her a poor candidate for anthracycline-based therapy. We opted to administer bendamustine with rituximab for a total of 6 cycles. She remains disease free 18 months after the completion of therapy.
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Affiliation(s)
- Taha Alrifai
- Division of Hematology/Oncology/Cell Therapy, Rush University Medical Center, Chicago, IL, USA
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9
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Park SI, Grover NS, Olajide O, Asch AS, Wall JG, Richards KL, Sobol AL, Deal AM, Ivanova A, Foster MC, Muss HB, Shea TC. A phase II trial of bendamustine in combination with rituximab in older patients with previously untreated diffuse large B-cell lymphoma. Br J Haematol 2016; 175:281-289. [PMID: 27448091 DOI: 10.1111/bjh.14232] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 05/23/2016] [Indexed: 01/08/2023]
Abstract
Bendamustine in combination with rituximab (BR) has been associated with high response rates and acceptable toxicity in older patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL). Evaluation of BR is warranted in the front-line setting for DLBCL patients not eligible for anthracyclines or for the elderly. In this phase II study, we enrolled DLBCL patients aged ≥65 years who were poor candidates for R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) to determine the efficacy and safety of BR in previously untreated stage II-IV DLBCL. Twenty-three patients were enrolled with a median age of 80 years. 52% of patients presented with poor functional status (Eastern Cooperative Oncology Group performance score of ≥2). The overall response rate was 78% with 12 complete responses (52%). At a median follow up of 29 months, the median overall survival was 10·2 months and the median progression-free survival was 5·4 months. The most common grade 3/4 adverse events were haematological. Combination therapy with BR demonstrates high response rates as front-line therapy in frail older patients with DLBCL, but survival rates were low. BR should be used with caution in future clinical trials involving older DLBCL patients with poor functional status.
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Affiliation(s)
- Steven I Park
- Division of Hematology/Oncology, University of North Carolina, Chapel Hill, NC, USA.
| | - Natalie S Grover
- Division of Hematology/Oncology, University of North Carolina, Chapel Hill, NC, USA
| | | | - Adam S Asch
- Division of Hematology/Oncology, University of Oklahoma College of Medicine, Oklahoma City, OK, USA
| | | | - Kristy L Richards
- Division of Hematology/Oncology, Weill Cornell Medical College, New York, NY, USA
| | - Anna L Sobol
- Seby B. Jones Regional Cancer Center, Boone, NC, USA
| | - Allison M Deal
- Division of Biostatistics and Data Management, University of North Carolina, Chapel Hill, NC, USA
| | - Anastasia Ivanova
- Division of Biostatistics and Data Management, University of North Carolina, Chapel Hill, NC, USA
| | - Matthew C Foster
- Division of Hematology/Oncology, University of North Carolina, Chapel Hill, NC, USA
| | - Hyman B Muss
- Division of Hematology/Oncology, University of North Carolina, Chapel Hill, NC, USA
| | - Thomas C Shea
- Division of Hematology/Oncology, University of North Carolina, Chapel Hill, NC, USA
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10
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Hitz F, Zucca E, Pabst T, Fischer N, Cairoli A, Samaras P, Caspar CB, Mach N, Krasniqi F, Schmidt A, Rothermundt C, Enoiu M, Eckhardt K, Berardi Vilei S, Rondeau S, Mey U. Rituximab, bendamustine and lenalidomide in patients with aggressive B-cell lymphoma not eligible for anthracycline-based therapy or intensive salvage chemotherapy - SAKK 38/08. Br J Haematol 2016; 174:255-63. [DOI: 10.1111/bjh.14049] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 01/22/2016] [Indexed: 12/19/2022]
Affiliation(s)
| | - Emanuele Zucca
- IOSI (Istituto Oncologico della Svizzera Italiana); Bellinzona Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ulrich Mey
- Kantonsspital Graubünden; Chur Switzerland
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11
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Fernández-Rodríguez C, Salar A, Navarro A, Gimeno E, Pairet S, Camacho L, Ferraro M, Serrano S, Besses C, Bellosillo B, Sanchez-Gonzalez B. Anti-tumor activity of the combination of bendamustine with vorinostat in diffuse large B-cell lymphoma cells. Leuk Lymphoma 2016; 57:692-9. [DOI: 10.3109/10428194.2015.1063143] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | - Antonio Salar
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Servei d’Hematologia, Hospital del Mar, Barcelona, Spain
| | - Alfons Navarro
- Human Anatomy Unit, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Eva Gimeno
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Servei d’Hematologia, Hospital del Mar, Barcelona, Spain
| | - Silvia Pairet
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Servei de Patologia, Hospital del Mar, Barcelona, Spain
| | - Laura Camacho
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | | | - Sergi Serrano
- Servei de Patologia, Hospital del Mar, Barcelona, Spain
| | - Carles Besses
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Servei d’Hematologia, Hospital del Mar, Barcelona, Spain
| | - Beatriz Bellosillo
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Servei de Patologia, Hospital del Mar, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Blanca Sanchez-Gonzalez
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Servei d’Hematologia, Hospital del Mar, Barcelona, Spain
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12
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Arcari A, Chiappella A, Spina M, Zanlari L, Bernuzzi P, Valenti V, Tani M, Marasca R, Cabras MG, Zambello R, Santagostino A, Ilariucci F, Carli G, Musto P, Savini P, Marino D, Ghio F, Gentile M, Cox MC, Vallisa D. Safety and efficacy of rituximab plus bendamustine in relapsed or refractory diffuse large B-cell lymphoma patients: an Italian retrospective multicenter study. Leuk Lymphoma 2015; 57:1823-30. [PMID: 26666433 DOI: 10.3109/10428194.2015.1106536] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Relapsed or refractory diffuse large B-cell lymphoma (DLBCL) not suitable for high dose chemotherapy with autologous stem cell transplantation (ASCT) has a dismal prognosis and no standard therapy. We designed an Italian multicenter retrospective study aimed at evaluating the safety and efficacy of rituximab plus bendamustine (R-B) as salvage treatment in patients not eligible for ASCT because of age and/or comorbidity or in patients with post-ASCT recurrence. Fifty-five patients with a median age of 76 years were included. The overall response rate was 50%, including 28% complete remission and 22% partial remission. The median overall survival (OS) was 10.8 months. The median progression free survival (PFS) was 8.8 months. Eleven patients are still alive and in complete remission at last follow-up (12-71 months). Toxicity was moderate, mainly grades 1 and 2. R-B showed promising efficacy results with an acceptable toxicity profile and should be further investigated, possibly in combination with novel drugs.
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Affiliation(s)
- Annalisa Arcari
- a Hematology Unit, Department of Onco-Hematology , Guglielmo da Saliceto Hospital , Piacenza , Italy
| | - Annalisa Chiappella
- b Department of Hematology , Città della Salute e della Scienza University Hospital , Torino , Italy
| | - Michele Spina
- c Department of Medical Oncology A , National Cancer Institute , Aviano , Italy
| | - Luca Zanlari
- d Day Hospital of Internal Medicine, Fiorenzuola d'Arda , Piacenza , Italy
| | - Patrizia Bernuzzi
- a Hematology Unit, Department of Onco-Hematology , Guglielmo da Saliceto Hospital , Piacenza , Italy
| | - Vanessa Valenti
- a Hematology Unit, Department of Onco-Hematology , Guglielmo da Saliceto Hospital , Piacenza , Italy
| | - Monica Tani
- e Department of Hematology , Santa Maria delle Croci Hospital , Ravenna , Italy
| | - Roberto Marasca
- f Division of Hematology, Department of Medical and Surgical Sciences , University of Modena and Reggio Emilia , Italy
| | | | - Renato Zambello
- h Hematology, Padua University School of Medicine , Padova , Italy
| | | | - Fiorella Ilariucci
- j Hematology Unit, Arcispedale Santa Maria Nuova-IRCCS , Reggio Emilia , Italy
| | - Giuseppe Carli
- k Department of Medicine , Section of Hematology, University of Verona , Italy
| | - Pellegrino Musto
- l Scientific Direction, IRCCS, Referral Cancer Center of Basilicata , Rionero in Vulture , Italy
| | - Paolo Savini
- m Medicine Department , Ospedale degli Infermi , Faenza , Italy
| | - Dario Marino
- n Division of Medical Oncology 1 , Istituto Oncologico Veneto-IRCCS , Padova , Italy
| | - Francesco Ghio
- o Department of Clinical and Experimental Medicine , Hematology, University of Pisa , Italy
| | - Massimo Gentile
- p Department of Hematology Unit , Ospedale Annunziata , Cosenza , Italy
| | | | - Daniele Vallisa
- a Hematology Unit, Department of Onco-Hematology , Guglielmo da Saliceto Hospital , Piacenza , Italy
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13
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Morrison VA, Hamlin P, Soubeyran P, Stauder R, Wadhwa P, Aapro M, Lichtman SM. Approach to therapy of diffuse large B-cell lymphoma in the elderly: the International Society of Geriatric Oncology (SIOG) expert position commentary. Ann Oncol 2015; 26:1058-1068. [PMID: 25635006 DOI: 10.1093/annonc/mdv018] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 12/15/2014] [Indexed: 01/22/2023] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) is a treatable and potentially curable malignancy that is increasing in prevalence in the elderly. Until recently, older patients with this malignancy were under-represented on clinical treatment trials, so optimal therapeutic approaches for these patients were generally extrapolated from the treatment of younger patients with this disorder. Because of heightened toxicity concerns, older patients were sometimes given reduced dose therapy, potentially negatively impacting outcome. Geriatric considerations including functional status and comorbidities often were not accounted for in treatment decisions. Because of these issues as well as the lack of treatment guidelines for the elderly population, the International Society of Geriatric Oncology convened an expert panel to review DLBCL treatment in the elderly and develop consensus guidelines for therapeutic approaches in this patient population. The following treatment guidelines address initial DLBCL therapy, in both limited and advanced stage disease, as well as approaches to the relapsed and refractory patient.
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Affiliation(s)
- V A Morrison
- Department of Medicine, University of Minnesota, Veterans Affairs Medical Center, Minneapolis.
| | - P Hamlin
- Memorial Sloan-Kettering Cancer Center, New York City, USA
| | - P Soubeyran
- Hematology/Oncology Service, University of Bordeaux and Institut Bergonié, Bordeaux, France
| | - R Stauder
- Department of Internal Medicine V (Haematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
| | - P Wadhwa
- Department of Medicine, University of Minnesota, Veterans Affairs Medical Center, Minneapolis
| | - M Aapro
- Institut Multidisciplinaire d'Oncologie, Clinique de Genolier, Genolier, Switzerland
| | - S M Lichtman
- Memorial Sloan-Kettering Cancer Center, New York City, USA; Memorial Sloan-Kettering Cancer Center, Commack, USA
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Davis CC, Cohen JB, Shah KS, Hutcherson DA, Surati MJ, Valla K, Panjic EH, Handler CE, Switchenko JM, Flowers CR. Efficacy and tolerability of anthracycline-based therapy in elderly patients with diffuse large B-cell lymphoma. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2015; 15:270-7. [PMID: 25704479 PMCID: PMC4869871 DOI: 10.1016/j.clml.2014.12.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 12/20/2014] [Accepted: 12/23/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Although diffuse large B-cell lymphoma (DLBCL) can be cured with rituximab and anthracycline-based therapy, within the elderly population there are additional factors to consider in selecting a treatment regimen including comorbid conditions, decreased drug metabolism, decreased hematologic reserve, reduced performance status, and regimen-related toxicity. PATIENTS AND METHODS We performed a retrospective cohort analysis of patients with DLBCL aged ≥ 65 years at time of diagnosis treated with either an anthracycline-containing regimen (ACR; n = 59) or a non-ACR (n = 13) to assess factors that led to treatment selection, tolerability, and outcomes. RESULTS The mean age was 73 years in the ACR and 77 years in the non-ACR group (P = .009), and median left ventricular ejection fraction (LVEF) at diagnosis was 60% in the ACR group and 45% in the non-ACR group (P < .001). With an ACR, elderly DLBCL patients had a median overall survival of 28 months and a 2-year progression-free survival (PFS) of 64%. After an ACR, 14 patients [24%] (out of 59 total patients) had a decrease in LVEF, 7 patients [15%] (% is based off of those who we had the data collected, so this is out of 45 with this specific data) required a dose reduction of the anthracycline, and 15 patients [33%] (% is based off of those who we had the data collected, so this is out of 45 with this specific data) could not complete the regimen as planned. Hospitalization due to toxicity occurred in 20 patients [44%] (% is based off of those who we had the data collected, so this is out of 45 with data) of patients in the ACR group and 3 patients [75%] (% is based off of those who we had the data collected, so this is out of 4 with this specific data) in the non-ACR group, and was the only predictor of overall survival. CONCLUSION Results of this study suggest that elderly patients with DLBCL experience meaningful PFS with ACRs, but a third experience toxicity requiring therapy modification. Future studies should examine larger patient populations and define treatments with outcomes similar to ACR that also decrease toxicity and hospitalization in the elderly DLBCL population.
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Affiliation(s)
- Christine C Davis
- Emory University Healthcare and Winship Cancer Institute, Atlanta, GA.
| | - Jonathon B Cohen
- Emory University Healthcare and Winship Cancer Institute, Atlanta, GA
| | - Katherine S Shah
- Emory University Healthcare and Winship Cancer Institute, Atlanta, GA
| | - Don A Hutcherson
- Emory University Healthcare and Winship Cancer Institute, Atlanta, GA
| | - Minal J Surati
- Emory University Healthcare and Winship Cancer Institute, Atlanta, GA
| | - Kelly Valla
- Emory University Healthcare and Winship Cancer Institute, Atlanta, GA
| | - Elyse H Panjic
- Emory University Healthcare and Winship Cancer Institute, Atlanta, GA
| | - Caitlin E Handler
- Emory University Healthcare and Winship Cancer Institute, Atlanta, GA
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15
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Kubuschok B, Held G, Pfreundschuh M. Management of diffuse large B-cell lymphoma (DLBCL). Cancer Treat Res 2015; 165:271-88. [PMID: 25655614 DOI: 10.1007/978-3-319-13150-4_11] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin lymphoma. While CHOP was the standard combination chemotherapy for 25 years, the incorporation of the CD20 antibody rituximab at the beginning of this century has considerably improved the outcome of all patients with DLBCL: Depending on the prognostic subgroup, only half to one-third of the patients die of their DLBCL compared to pre-rituximab era. Treatment is usually tailored according to the individual risk profile of a DLBCL patient according to the International Prognostic Index (IPI). Assignment of DLBCL according to the gene expression profile into DLBLC originating from a germinal center B cell (GC type) or from an activated B cell (ABC type) has provided novel insights into the pathogenesis of the respective DLBCL, identified molecules which are indispensable for the survival of the lymphoma cells and provided targets for novel "targeted therapies" drugs. Incorporating these new drugs into combination immunochemotherapy or substituting single drugs in the R-CHOP combination will result in even higher cure rates of and/or less toxicity for patients with DLBCL in the decade to come.
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Affiliation(s)
- Boris Kubuschok
- German High-Grade Non-Hodgkin-Lymphoma Study Group (DSHNHL), Department Internal Medicine I, Saarland University Medical School, 66421, Homburg, Saarland, Germany
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16
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Bendamustine plus rituximab for relapsed or refractory diffuse large B cell lymphoma: a retrospective analysis. Leuk Res 2014; 38:1446-50. [DOI: 10.1016/j.leukres.2014.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 09/30/2014] [Accepted: 10/09/2014] [Indexed: 11/17/2022]
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17
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Gil L, Kazmierczak M, Kroll-Balcerzak R, Komarnicki M. Bendamustine-based therapy as first-line treatment for non-Hodgkin lymphoma. Med Oncol 2014; 31:944. [PMID: 24752517 PMCID: PMC4006123 DOI: 10.1007/s12032-014-0944-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 03/27/2014] [Indexed: 11/25/2022]
Abstract
Recently, bendamustine has become an important agent in the treatment for patients with lymphoid malignancies. Although the drug has received approval for second-line therapy in indolent lymphoma, a growing body of evidence suggests its efficacy and safety in first-line use. The results of randomised and observational studies with bendamustine as front-line therapy in non-Hodgkin lymphoma (NHL) with emphasis on efficacy and toxicity are presented. Furthermore, completed and ongoing clinical trials evaluating upfront bendamustine effectiveness in combination with other agents are discussed. The review refers mainly to indolent lymphoma, mantle cell lymphoma and aggressive lymphoma, as the most commonly diagnosed NHL types. Finally, we elaborated on the safety profile of bendamustine and the perspectives of using the drug as a first-line therapy.
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Affiliation(s)
- Lidia Gil
- Department of Haematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, 84 Szamarzewski Street, 60-569, Poznan, Poland,
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18
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Derenzini E, Zinzani PL, Cheson BD. Bendamustine: role and evidence in lymphoma therapy, an overview. Leuk Lymphoma 2014; 55:1471-8. [DOI: 10.3109/10428194.2013.842986] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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19
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Bendamustine combined with rituximab for patients with relapsed or refractory diffuse large B cell lymphoma. Ann Hematol 2013; 93:403-9. [PMID: 23955074 PMCID: PMC3918114 DOI: 10.1007/s00277-013-1879-x] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 08/05/2013] [Indexed: 01/12/2023]
Abstract
Patients with relapsed or refractory diffuse large B cell lymphoma (DLBCL) are treated with salvage regimens and may be considered for high-dose chemotherapy and autologous stem cell transplantation if disease is chemosensitive. Bendamustine is active in indolent B cell lymphomas and chronic lymphocytic leukemia but has not been extensively studied in aggressive lymphomas. This trial examines the combination of bendamustine and rituximab in patients with relapsed and refractory DLBCL. Patients received bendamustine at 90 mg/m2 (n = 2) or 120 mg/m2 (n = 57) on days 1 and 2 and rituximab at 375 mg/m2 on day 1 every 28 days for up to 6 cycles. The study evaluated objective response rate (ORR), duration of response (DOR), progression-free survival (PFS), and treatment safety. Fifty-nine patients were treated, and 48 were evaluable for response. Median age was 74; 89 % had stage III or IV disease, and 63 % had high revised International Prognostic Index scores; the median number of prior therapies was 1. Based on analysis using the intent-to-treat population, the ORR was 45.8 % (complete response, 15.3 %; partial response, 30.5 %). The median DOR was 17.3 months, and the median PFS was 3.6 months. Grade 3 or 4 hematological toxicities included neutropenia (36 %), leukopenia (29 %), thrombocytopenia (22 %), and anemia (12 %). The combination of bendamustine and rituximab showed modest activity in patients with relapsed and refractory DLBCL and has an acceptable toxicity profile.
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20
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Boslooper K, Kibbelaar R, Storm H, Veeger NJGM, Hovenga S, Woolthuis G, van Rees B, de Graaf E, van Roon E, Kluin-Nelemans HC, Joosten P, Hoogendoorn M. Treatment with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone is beneficial but toxic in very elderly patients with diffuse large B-cell lymphoma: a population-based cohort study on treatment, toxicity and outcome. Leuk Lymphoma 2013; 55:526-32. [PMID: 23734653 DOI: 10.3109/10428194.2013.810737] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
To assess treatment strategies, toxicity and outcome in very elderly patients (aged ≥ 75 years) diagnosed with diffuse large B-cell lymphoma (DLBCL) in the rituximab era, an observational population-based cohort study was performed. From 103 patients with a median age of 81 years, data of clinical characteristics, treatment, toxicity and outcome were evaluated. Advanced stage DLBCL was documented in 74 patients. In 80 patients chemotherapy was initiated; 70 patients received rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone (R-CHOP). In this group, 39 patients completed all cycles and 30 patients achieved a complete remission. Severe chemotherapy-related toxicity occurred in 69%. Two-year overall survival was 70% for elderly patients who completed chemotherapy, 28% for those treated with incomplete or suboptimal chemotherapy and 21% for those receiving palliative radiotherapy or supportive care. In conclusion, the ability to complete R-CHOP was associated with better overall survival compared to other treatment strategies at the expense of severe treatment-related toxicity.
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Affiliation(s)
- Karin Boslooper
- Department of Hematology, Medical Center Leeuwarden , Leeuwarden , The Netherlands
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21
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Hitz F, Fischer N, Pabst T, Caspar C, Berthod G, Eckhardt K, Berardi Vilei S, Zucca E, Mey U. Rituximab, bendamustine, and lenalidomide in patients with aggressive B cell lymphoma not eligible for high-dose chemotherapy or anthracycline-based therapy: phase I results of the SAKK 38/08 trial. Ann Hematol 2013; 92:1033-40. [PMID: 23592273 DOI: 10.1007/s00277-013-1751-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 03/30/2013] [Indexed: 11/24/2022]
Abstract
This phase I trial was designed to develop a new effective and well-tolerated regimen for patients with aggressive B cell lymphoma not eligible for front-line anthracycline-based chemotherapy or aggressive second-line treatment strategies. The combination of rituximab (375 mg/m(2) on day 1), bendamustine (70 mg/m(2) on days 1 and 2), and lenalidomide was tested with a dose escalation of lenalidomide at three dose levels (10, 15, or 20 mg/day) using a 3 + 3 design. Courses were repeated every 4 weeks. The recommended dose was defined as one level below the dose level identifying ≥2/6 patients with a dose-limiting toxicity (DLT) during the first cycle. Thirteen patients were eligible for analysis. Median age was 77 years. WHO performance status was 0 or 1 in 12 patients. The Charlson Comorbidity Index showed relevant comorbidities in all patients. Two DLTs occurred at the second dose level (15 mg/day) within the first cycle: one patient had prolonged grade 3 neutropenia, and one patient experienced grade 4 cardiac adverse event (myocardial infarction). Additional grade 3 and 4 toxicities were as follows: neutropenia (31 %), thrombocytopenia (23 %), cardiac toxicity (31 %), fatigue (15 %), and rash (15 %). The dose of lenalidomide of 10 mg/day was recommended for a subsequent phase II in combination with rituximab 375 mg/m(2) on day 1 and bendamustine 70 mg/m(2) on days 1 and 2.
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Affiliation(s)
- F Hitz
- Kantonsspital St. Gallen, St. Gallen, Switzerland.
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22
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Ghesquières H, Stamatoullas A, Casasnovas O, Morschhauser F, Gyan E, Gabarre J, Malphettes M, Clément L, Ferlay C, Brice P. Clinical experience of bendamustine in relapsed or refractory Hodgkin lymphoma: a retrospective analysis of the French compassionate use program in 28 patients. Leuk Lymphoma 2013; 54:2399-404. [DOI: 10.3109/10428194.2013.776165] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Hervé Ghesquières
- Service d’Onco-Hématologie Centre Léon Bérard, Université Claude Bernard, Lyon, France
| | | | | | | | - Emmanuel Gyan
- Service d’Hématologie et Thérapie cellulaire, Faculté de Médecine de Tours, CIC INSERM U202, CHU de Tours, France
| | - Jean Gabarre
- Service d’Hématologie Clinique, Hôpital Pitié Salpetrière, AP-HP, Paris, France
| | - Marion Malphettes
- Service d’Immuno-Hématologie Hôpital Saint-Louis, AP-HP, Paris, France
| | | | - Céline Ferlay
- Unité de Biostatistique et d’Evaluation des Thérapeutiques, Centre Léon Bérard, Université Claude Bernard, Lyon, France
| | - Pauline Brice
- Service d’Hématologie Clinique, Hôpital Saint-Louis, AP-HP, Paris, France
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Li Z, Caulfield T, Qiu Y, Copland JA, Tun HW. Pharmacokinetics of bendamustine in the central nervous system: chemoinformatic screening followed by validation in a murine model. MEDCHEMCOMM 2012. [DOI: 10.1039/c2md20233f] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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