Lenalidomide in combination with R‐ESHAP in patients with relapsed or refractory diffuse large B‐cell lymphoma: A phase 2 study from GELTAMO

• Published in: British journal of haematology Vol. 203; no. 2; pp. 202 - 211
• Main Authors: Martín García‐Sancho, A., Baile, M., Rodríguez, G., Dlouhy, I., Sancho, J. M., Jarque, I., González‐Barca, E., Salar, A., Espeso, M., Grande, C., Bergua, J., Montes‐Moreno, S., Redondo, A., Enjuanes, A., Campo, E., López‐Guillermo, A., Caballero, D.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.10.2023
• Subjects: Hematology; Immunotherapy; Lymphoma; Neutropenia; Remission; Targeted cancer therapy; Thrombocytopenia; Transplantation; salvage regimen; autologous stem-cell transplantation; diffuse large B-cell lymphoma; lenalidomide
• ISSN: 0007-1048; 1365-2141; 1365-2141
• DOI: 10.1111/bjh.18989

Diffuse large B‐cell lymphoma (DLBCL) patients with relapsed or refractory (RR) disease have poor outcomes with current salvage regimens. We conducted a phase 2 trial to analyse the safety and efficacy of adding lenalidomide to R‐ESHAP (LR‐ESHAP) in patients with RR DLBCL. Subjects received 3 cycles of lenalidomide 10 mg/day on days 1–14 of every 21‐day cycle, in combination with R‐ESHAP at standard doses. Responding patients underwent autologous stem‐cell transplantation (ASCT). The primary endpoint was the overall response rate (ORR) after 3 cycles. Centralized cell‐of‐origin (COO) classification was performed. Forty‐six patients were included. The ORR after LR‐ESHAP was 67% (35% of patients achieved complete remission). Patients with primary refractory disease ( n  = 26) had significantly worse ORR than patients with non‐refractory disease (54% vs. 85%, p  = 0.031). No differences in response rates according to the COO were observed. Twenty‐eight patients (61%) underwent ASCT. At a median follow‐up of 41 months, the estimated 3‐year PFS and OS were 42% and 48%, respectively. The most common grade ≥3 adverse events were thrombocytopenia (70% of patients), neutropenia (67%) and anaemia (35%). There were no treatment‐related deaths during LR‐ESHAP cycles. In conclusion, LR‐ESHAP is a feasible salvage regimen with promising efficacy results for patients with RR DLBCL.