Rituximab and ESHAP as Second-line Therapy for Relapsed or Primary Refractory Diffuse Large B Cell Lymphoma: The Experience of a Single Center in Korea

Ock Bae Ko; Shin Kim; Dae Ho Lee; Sang We Kim; Jooryung Huh; Cheolwon Suh

doi:10.5045/kjh.2007.42.4.309

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Ko, Kim, Lee, Kim, Huh, and Suh: Rituximab and ESHAP as Second-line Therapy for Relapsed or Primary Refractory Diffuse Large B Cell Lymphoma: The Experience of a Single Center in Korea

Original Article

Korean J Hematol 2007;42(4):309-316.

Published online: 19 January 2007

DOI: https://doi.org/10.5045/kjh.2007.42.4.309

Rituximab and ESHAP as Second-line Therapy for Relapsed or Primary Refractory Diffuse Large B Cell Lymphoma: The Experience of a Single Center in Korea

Ock Bae Ko¹, Shin Kim¹, Dae Ho Lee¹, Sang We Kim¹, Jooryung Huh², Cheolwon Suh^1,

¹Department of Internal Medicine, Seoul, Korea

²Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Correspondence : Cheolwon Suh, M.D. Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap 2-dong, Songpa-gu, Seoul 138-736, Korea Pel: +82-2-3010-3209, Fax: +82-2-3010-6961 E-mail: csuh@amc.seoul.kr

Received 17 August 2007 Revised 8 September 2007 Accepted 15 September 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background:

The remission status prior to autologous stem cell transplantation (ASCT) influences the transplantation outcome in patients with relapsed or primary refractory diffuse large B cell lymphoma (DLBCL), a complete response (CR) generally being more favorable than a partial response (PR). This study investigated whether the addition of rituximab to the ESHAP chemotherapy regimen (R-ESHAP) could improve the CR rate in patients with relapsed or primary refractory DLBCL.

Methods:

Retrospective analysis was performed with DLBCL registry data.

Results:

Sixteen patients who had previously received one course of chemotherapy were administered R-ESHAP (median 3 cycles; range 1∼6). The overall response rate of 75% (CR=50%; PR=25%), was significantly better than that achieved with ESHAP alone in 13 historical controls (31%; P=0.027). The toxicity was tolerable, with two febrile neutropenia episodes in 51 treatment cycles. Seven of the 12 responders to R-ESHAP underwent ASCT with BEAM. After a median follow-up of 17 months, the median survival endpoints have not been reached.

Conclusion:

R-ESHAP appears to induce high CR rates in relapsed or refractory DLBCL with acceptable toxicity.

Keywords: Rituximab, ESHAP, Salvage chemotherapy, DLBCL

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Fig. 1

Overall survival of patients treated with R-ESHAP or ESHAP.

Fig. 2

Progression-free survival of patients treated with R-ESHAP or ESHAP.

Table 1.

Patient characteristics

Characteristic	R-ESHAP (n=16)	ESHAP historical controls (n=13)	P
Median age (range), years	47 (15∼70)	57 (18∼73)	NS
Gender, n (%)			NS
Male	11 (69)	7 (54)
Female	5 (31)	6 (46)
Previous chemotherapy, n (%)			NS
CHOP	8 (50)	12 (92)
ESHAP	2 (13)	0
ICE	2 (13)	0
R-CHOP	4 (25)	1 (8)
Disease status, n (%)			NS
Relapsed	4 (25)	7 (54)
Primary refractory	12 (75)	6 (46)
Second-line age-adjusted IPI, n (%)			NS
Low/low?intermediate	4 (25)	2 (15)
High-inter mediate/high	12 (75)	11 (85)
Median chemotherapy cycles (range)	3 (1∼6)	3 (1∼6)	NS

Abbreviations: NS, not significant; IPI, International Prog-Nostic Index.

Table 2.

Response to R-ESHAP compared with ESHAP historical controls

Response	No. of patients (%)		P
Response	R-ESHAP (n=16)	ESHAP historical controls (n=13)	P
Complete response	8 (50)	2 (15)
Partial response	4 (25)	2 (15)	0.077
Stable disease	0	2 (15)	0.077
Progression	4 (25)	7 (54)
Overall response	12 (75)	4 (31)	0.027

Table 3.

Incidences of grade 3 or 4 toxicities

Toxicity	No. (%) of cycles
Toxicity	R-ESHAP (51 cycles)	ESHAP historical controls (36 cycles)
Neutropenia	2 (4)	2(6)
Febrile neutropenia	2 (4)	1(3)
Thrombocytopenia	3 (6)	3(8)
Documented infection	1 (2)	1(3)
Azotemia	0	0

Toxicity was graded according to the National Cancer Institute common toxicity criteria, version 3.0.

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