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Johnston PB, LaPlant B, Kurtin P, Habermann T, Moore D, Nabbout N, Nikcevich D, Rowland K, Witzig T. Salvage chemotherapy with rituximab, oxaliplatin, cytosine arabinoside, and dexamethasone (ROAD) in patients with relapsed CD20+ aggressive B-cell lymphoma. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.8556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8556 Background: In the original PARMA trial it was demonstrated that salvage chemotherapy with DHAP followed by autologous bone marrow transplant resulted in increased overall survival over salvage chemotherapy with DHAP alone in patients with aggressive lymphomas. The current study was designed to assess safety and feasibility of ROAD as a salvage chemotherapy regimen which could be administered as an inpatient or outpatient. Methods: Patients received immunochemotherapy on the following schedule: rituximab 375 mg/m2 weekly × 4, oxaliplatin 130 mg/m2 on day 2, Ara C 2000mg/m2 x 2 doses on day 2 and dexamethasone 40 mg on days 2–5, with OAD repeated at 3 week intervals (up to 6 cycles). Patients were considered for autologous stem cell transplantation after 2 cycles if eligible. Eligible histologies included diffuse large B cell lymphoma, mantle cell lymphoma and transformed lymphoma in first relapse. Results: 50 patients were accrued from Aug 2006 through Jul 2008: 5 patients were deemed ineligible after central pathology review. Baseline characteristics of eligible patients included median age 69 (range 23 - 77), 53% were male, 53% had advanced stage at relapse, LDH was elevated in 58% and all patients had an ECOG PS of 2 or less. Patients received a median of 2 cycles of therapy (range 1–6) with 39/45 receiving treatment in cycle 2, with 12 patients continuing beyond 2 cycles. 31 patients experienced grade III/IV hematologic toxicity and 22 patients had grade III/IV non-hematologic toxicity, primarily febrile neutropenia. One patient developed grade III nephrotoxicity due to disease progression. Twenty patients received their treatments exclusively as outpatients. 26 responses were seen in the 45 eligible patients (58%, 95% CI: 44–74%), with 20 responding patients proceeding to autologous SCT. Conclusions: ROAD is a safe and effective salvage chemotherapy regimen for relapsed aggressive lymphoma, including as a preparatory regimen prior to stem cell transplant. It appears to have similar response rates to R-DHAP in a similar patient population, but without the potential nephrotoxicity (data from prior published study from NCCTG). ROAD can be safely administered as an inpatient or outpatient. No significant financial relationships to disclose.
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Affiliation(s)
- P. B. Johnston
- Mayo Clinic, Rochester, MN; Cancer Center of Kansas, Wichita, KS; Duluth Clinic, Duluth, MN; Carle Clinic, Danville, IL
| | - B. LaPlant
- Mayo Clinic, Rochester, MN; Cancer Center of Kansas, Wichita, KS; Duluth Clinic, Duluth, MN; Carle Clinic, Danville, IL
| | - P. Kurtin
- Mayo Clinic, Rochester, MN; Cancer Center of Kansas, Wichita, KS; Duluth Clinic, Duluth, MN; Carle Clinic, Danville, IL
| | - T. Habermann
- Mayo Clinic, Rochester, MN; Cancer Center of Kansas, Wichita, KS; Duluth Clinic, Duluth, MN; Carle Clinic, Danville, IL
| | - D. Moore
- Mayo Clinic, Rochester, MN; Cancer Center of Kansas, Wichita, KS; Duluth Clinic, Duluth, MN; Carle Clinic, Danville, IL
| | - N. Nabbout
- Mayo Clinic, Rochester, MN; Cancer Center of Kansas, Wichita, KS; Duluth Clinic, Duluth, MN; Carle Clinic, Danville, IL
| | - D. Nikcevich
- Mayo Clinic, Rochester, MN; Cancer Center of Kansas, Wichita, KS; Duluth Clinic, Duluth, MN; Carle Clinic, Danville, IL
| | - K. Rowland
- Mayo Clinic, Rochester, MN; Cancer Center of Kansas, Wichita, KS; Duluth Clinic, Duluth, MN; Carle Clinic, Danville, IL
| | - T. Witzig
- Mayo Clinic, Rochester, MN; Cancer Center of Kansas, Wichita, KS; Duluth Clinic, Duluth, MN; Carle Clinic, Danville, IL
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