Preliminary outcome of rituximab-containing salvage regimens on relapsed or refractory B-cell non-Hodgkin’s lymphoma: single institution experience

摘要

Objective: The prognosis of relapsed or refractory B-cell lymphoma is poor, with a short-term survival after conven- tional second-line chemotherapy. Rituximab, a chimeric anti-CD20 antigen, in combination with CHOP or CHOP-like chemo- therapy may improve both disease free survival (DFS) and overall survival (OS) of naive patients, but its role in the second-line therapy for relapsed non-Hodgkin’s Lymphoma (NHL) remains to be defined. This study aimed to evaluate the efficacy of rituximab-containing salvage regimens for relapsed or refractory NHL, and observe the toxicities. Methods: The clinical data of 54 patients, who were with relapsed or refractory NHL and treated in the Cancer Center of Sun Yat-sen University, were analyzed retrospectively. Of the 54 patients, 29 were man, 25 were women, with a median age of 52.5 years old (range 18 to 75); 50 patients (92.6%) scored 0–1 for the ECOG performance status; for second-line international prognostic index (sIPI), 21 (38.9%) scored 0–1, 30 (55.6%) scored 2 to 3, and 3 (5.6%) scored 4–5; 40 cases were diffuse large B-cell lymphoma (DLBCL), accounting for 74.1% of all subtypes. Rituximab was administered intravenously at a dose of 375 mg/m2 at the day before each chemotherapy cycle. The second or third-line salvage regimens included EPOCH, CHOP, DHAP, DICE, IVAC, IMVP-16 and FND. Results: Of the 54 patients, 49 received retuximab-containing salvage regimens. The objective response rate of the 45 evaluable cases was 68.8%, with a complete remission (CR) rate of 37.7%; 3 patients achieved CR after radiotherapy follow- ing rituximab-based regimens and 3 achieved CR after autologous hematopoietic stem cell transplantation. The most frequent adverse events were leucopenia, nausea and alopecia. The addition of rituximab to chemotherapy only elevated the occurrence of mild infusion-related reactions, such as chills, fever and pruritus. The median follow-up time was 18 months (range 2–86 months); 5 patients were lost, 24 were dead (23 died of lymphoma, and 1 died of severe hepatitis), the other patients remained alive. The median survival time was 32 months (range 2–86 months, 95% confidential interval 16–48 months). The 1-, 2- and 3-year OS rates were 70.6%, 53.6% and 41.5%, respectively. The median TTP was 6 months (range 0–52 months). The median PFS was 10 months (range 0–47 months, 95% CI 0–26 months). The 1- and 2-year PFS were 49.3% and 41.3%. Conclusion: Rituximab-containing salvage regimens are effective and well tolerated therapy for patients with relapsed or refractory B-cell NHL, even those were extensively treated.