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Blood, 15 May 2004, Vol. 103, No. 10, pp. 3684-3688.
Prepublished online as a Blood First Edition Paper on January 22, 2004; DOI 10.1182/blood-2003-11-3911.
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CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Rituximab and ICE as second-line therapy before autologous stem cell transplantation for relapsed or primary refractory diffuse large B-cell lymphoma
Tarun Kewalramani,
Andrew D. Zelenetz,
Stephen D. Nimer,
Carol Portlock,
David Straus,
Ariela Noy,
Owen O'Connor,
Daniel A. Filippa,
Julie Teruya-Feldstein,
Alison Gencarelli,
Jing Qin,
Alyson Waxman,
Joachim Yahalom, and
Craig H. Moskowitz
From the Departments of Medicine, Radiation Oncology, Pathology, and Biostatistics and Epidemiology, Memorial Sloan-Kettering Cancer Center, New York, NY.
Patients with relapsed or primary refractory diffuse large B-cell lymphoma (DLBCL) who achieve complete response (CR) before autologous stem cell transplantation (ASCT) generally have better outcomes than those who achieve only partial response (PR). We investigated whether adding rituximab to the ifosfamide-carboplatin-etoposide (ICE) chemotherapy regimen (RICE) could increase the CR rate of patients with DLBCL under consideration for ASCT. Thirty-six eligible patients were treated with RICE, and 34 received all 3 planned cycles. The CR rate was 53%, significantly better than the 27% CR rate (P = .01) achieved among 147 similar consecutive historical control patients with DLBCL treated with ICE; the PR rate was 25%. Febrile neutropenia was the most frequent grade 3 or 4 nonhematologic toxicity; it occurred in 7.5% of delivered cycles. No patient had RICE-related toxicity that precluded ASCT. The median number of CD34+ cells per kilogram mobilized was 6.3 x 106. Progression-free survival rates of patients who underwent transplantation after RICE were marginally better than those of 95 consecutive historical control patients who underwent transplantation after ICE (54% vs 43% at 2 years; P = .25). RICE appears to induce very high CR rates in patients with relapsed and refractory DLBCL; however, further studies are necessary to determine whether this treatment regimen will improve outcomes after ASCT.
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