Response to Re-Treatment with Rituximab Plus Salvage-Chemotherapy in Refractory or Relapsed Aggressive Non-Hodgkin’s Lymphoma.

The efficacy of re-therapy with rituximab immuno-chemotherapy was analysed in 20 consecutive patients with relapsed or progressive aggressive Non Hodgkin’s lymphoma after initial treatment with rituximab plus chemotherapy. Ten patients had a diffuse large B-cell lymphoma, seven had a mantle cell lymphoma and three a grade III follicular lymphoma. At primary diagnosis, the IPI was high-intermediate or high in 75% of the patients and the median age was 55 years (range 36–72 years). The overall response rate of primary immuno-chemotherapy was 75% (15/20 patients) with a complete remission in 8/20 patients (40%). After relapse, 53 % of these patients (8/15) responded again to immunochemotherapy: two patients had a second complete and six a second partial remission. None of the five patients with primary progressive disease responded to a conventional immuno-chemo salvage therapy. After re-therapy with rituximab plus salvage chemotherapy, ten patients received at least one cycle of high dose chemotherapy followed by SCT. One patient did receive HD-chemotherapy and an autologous graft solely, two patients did receive HD-radio-immunotherapy followed by an autologous graft and seven patients finally received HDT and an allogeneic transplant. Allogeneic SCT resulted in a CR in 6 out of 7 patients. One of these ten patients relapsed after HDT consolidation. Six out of ten patients without HDT consolidation after immuno-chemotherapy progressed after secondary treatment, 4 patients are alive without progression (SD, PR) but follow up is short (7, 10, 13 and 16 months). Conclusion: A substantial proportion (53%) of patients with relapse after rituximab immuno-chemotherapy did response to rituximab containing salvage therapy. Patients with progressive disease under immuno-chemotherapy did not respond to such salvage therapy. Without additional consolidation by HDT the risk of progression after successful salvage with rituximab and salvage-chemotherapy is high.