Abstract
Rituximab is active as single agent in relapsed CD20-positive NHL. Second line chemotherapeutic regimens in NHL are mainly based on cisplatin (DDP) and are most frequently employed as cytoreductive regimens for high dose chemotherapy and for peripheral blood CD34-positive (PBSC) harvesting. On the basis of preclinical and clinical studies, the substitution of DDP with oxaliplatin (OXDDP) in regimens like DHAP can result in a lower toxicity and higher activity. We studied the tolerability and efficacy of R-DHAOX regimen in the treatment of relapsed and refractory NHL. From November 2002 until June 2004, 33 pts affected by relapsed/refractory NHL were treated with R-DHAOX regimen (Rituximab 375 mg/m2, e.v. day 1, Desametazone 40 mg e.v. days 1–4, Oxaliplatin 130 mg/m2 e.v. day 2 and Cytarabine 2000 mg/m2 e.v. twice a day, day 3). The median age was 51 yrs (range 19–74). Twenty-one pts were in first relapse, 7 pts >1 relapse and 5 pts refractory to the first line. The results are summarized in table 1. These data suggested that the R-DHAOx regimen is a novel combination in salvage therapy for relapsed/refractory NHL. It has clinically significant activity with an acceptable toxicity profile, even in HIV-positive pts. R-DHAOX permits adequate stem cell harvest with G-CSF mobilisation and in our experience no delay in engraftment occurred. Supported by ISS and AIRC grants. Table 1
°30 pts evaluable; ^5 HIV-positive pts, 1 HCV-positive pts, 22 elegible for ASCT | |
M/F | 21/12 |
PS | 1 (0–2) |
Median age | 51 (19–74) |
HIV-positive | 10 |
HCV-positive | 1 |
Histology | |
Lymphocytic | 2 |
Follicular | 8 (24%) |
Mantle | 2 |
Diffuse large cell | 18 (55%) |
Burkitt | 1 |
Large cell CD30+ | 2 |
Stage | |
II | 1 |
III | 6 (18%) |
IV | 26 (79%) |
s-IPI | |
0–1 | 10 (30%) |
>1 | 23 (70%) |
# previous lines | 1 (1–2) |
Dose reduction | 65 (55%) |
Toxicity | |
Neutropenia G3/G4 | 22 (66%) |
Anemia G3/G4 | 8 (24%) |
Thrombocytopenia G3/G4 | 21 (64%) |
Mucositis G3/G4 | 2 |
Neurotoxicity G3/G4 | 1 |
Response° | |
CR | 8 (27%) |
PR | 13 (43%) |
SD | 1 (3%) |
PRO | 8 (27%) |
Day of PBSC peak | +14 (12–18) |
CFU-GM x104/kg | 93 (10.9–230) |
CD34+ 106/kg | 7 (0.65–20) |
# apheresis | 1 (1–2) |
High dose chemotherapy^ | 15 (68%) |
°30 pts evaluable; ^5 HIV-positive pts, 1 HCV-positive pts, 22 elegible for ASCT | |
M/F | 21/12 |
PS | 1 (0–2) |
Median age | 51 (19–74) |
HIV-positive | 10 |
HCV-positive | 1 |
Histology | |
Lymphocytic | 2 |
Follicular | 8 (24%) |
Mantle | 2 |
Diffuse large cell | 18 (55%) |
Burkitt | 1 |
Large cell CD30+ | 2 |
Stage | |
II | 1 |
III | 6 (18%) |
IV | 26 (79%) |
s-IPI | |
0–1 | 10 (30%) |
>1 | 23 (70%) |
# previous lines | 1 (1–2) |
Dose reduction | 65 (55%) |
Toxicity | |
Neutropenia G3/G4 | 22 (66%) |
Anemia G3/G4 | 8 (24%) |
Thrombocytopenia G3/G4 | 21 (64%) |
Mucositis G3/G4 | 2 |
Neurotoxicity G3/G4 | 1 |
Response° | |
CR | 8 (27%) |
PR | 13 (43%) |
SD | 1 (3%) |
PRO | 8 (27%) |
Day of PBSC peak | +14 (12–18) |
CFU-GM x104/kg | 93 (10.9–230) |
CD34+ 106/kg | 7 (0.65–20) |
# apheresis | 1 (1–2) |
High dose chemotherapy^ | 15 (68%) |
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