Rituximab‐PECC induction followed by 90Y‐ibritumomab tiuxetan consolidation in relapsed or refractory DLBCL patients who are ineligible for or have failed ASCT: results from a phase II HOVON study

• Published in: British journal of haematology Vol. 187; no. 3; pp. 347 - 355
• Main Authors: Lugtenburg, Pieternella J., Zijlstra, Josee M., Doorduijn, Jeanette K., Böhmer, Lara H., Hoogendoorn, Mels, Berenschot, Henriette W., Beeker, Aart, van der Burg‐de Graauw, Nicole C., Schouten, Harry C., Bilgin, Yavuz M., Kersten, Marie‐Jose, Koene, Harry R., Herbers, Alexandra H. E., de Jong, Daphne, Hijmering, Nathalie, Lam, King H., Chiţu, Dana, Brouwer, Rolf E., van Imhoff, Gustaaf W.
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Publishing Ltd 01.11.2019
• Subjects: 90Y‐ibritumomab tiuxetan; Autografts; Chlorambucil; Consolidation; diffuse large B‐cell lymphoma; Etoposide; Hematology; Immunotherapy; Lymphoma; Medical prognosis; Monoclonal antibodies; PECC; Prednisolone; relapse; Remission; Rituximab; Slopes; Stem cell transplantation; Stem cells; Survival; Targeted cancer therapy; Toxicity; Transplantation; Yttrium isotopes
• ISSN: 0007-1048; 1365-2141
• DOI: 10.1111/bjh.16087

Summary Patients with relapsed/refractory diffuse large B‐cell lymphoma (DLBCL) after, or ineligible for, autologous stem cell transplantation (ASCT) have a dismal prognosis. This phase II study evaluated treatment with R‐PECC (rituximab, prednisolone, etoposide, chlorambucil, lomustine), every 28 days for 4 cycles in 62 patients, followed by radio‐immunotherapy consolidation with 90Y‐ibritumomab tiuxetan in responsive patients. Primary endpoints were failure‐free survival (FFS) and incidence of grade ≥3 adverse events from start of 90Y‐ibritumomab tiuxetan. The overall response rate after R‐PECC was 50%. Twenty‐nine of 31 responsive patients proceeded to 90Y‐ibritumomab tiuxetan. Five out of 15 partial remission patients converted to complete remission after 90Y‐ibritumomab tiuxetan. One‐year FFS and overall survival (OS) from start of 90Y‐ibritumomab tiuxetan was 52% (95% confidence interval [CI], 33–68%) and 62% (95% CI, 42–77%), respectively. One‐year FFS and OS from start of R‐PECC was 28% (95% CI, 17–39%) and 49% (95% CI, 36–61%), respectively. Toxicities of R‐PECC and 90Y‐ibritumomab tiuxetan were mainly haematological. In conclusion, for relapsed DLBCL patients the largely oral R‐PECC regimen achieves promising response rates, combined with an acceptable safety profile. Consolidation with 90Y‐ibritumomab tiuxetan resulted in long‐term response durations in approximately one third of the patients that received it.