IVAC with or without rituximab for relapsed or refractory B-cell non-Hodgkin lymphomas: Real-world experience in the modern era Journal Article
| Authors: | Buege, M. J.; Dao, P. H.; Drill, E.; LeVoir, A.; Pak, T.; Peterson, T. J.; Straus, D. J. |
| Article Title: | IVAC with or without rituximab for relapsed or refractory B-cell non-Hodgkin lymphomas: Real-world experience in the modern era |
| Abstract: | IVAC +/- rituximab (R) is used as standalone therapy in relapsed/refractory non-Hodgkin lymphomas (NHL) despite a paucity of data. We report a retrospective cohort of 54 patients with relapsed/refractory NHL treated with IVAC +/- R. Objective response rate was 48%; severe toxicity and treatment-related mortality were noted. While IVAC's clinical activity is unclear, profound hematologic toxicity and complications despite preventive measures require careful consideration of alternatives. Introduction: Part B of the modified Magrath regimen (IVAC) +/- rituximab (R) is recommended as standalone therapy by national guidelines for management of relapsed/refractory Burkitt lymphoma, and is used in other non-Hodgkin lymphomas (NHL). Activity of IVAC in B-cell NHL, particularly with R, and its toxicity remain incompletely described. Patients and Methods: We reviewed patients with relapsed/refractory B-cell NHL treated with IVAC +/- R between 2004 and 2019 at Memorial Sloan Kettering Cancer Center to assess efficacy and toxicity. Results: Among 54 eligible patients (median 2 prior lines of therapy), 76% had diffuse large B-cell lymphoma; 30% had central nervous system involvement at IVAC initiation. Objective response rate was 48%, At median 22-month follow-up, median progression-free and overall survival were 3.1 months and 4.9 months, respectively. Grade >= 3 anemia (93%), neutropenia (94%), and thrombocytopenia (100%; all grade 4) were common. Febrile neutropenia occurred in 65% and did not appear to be influenced by use of antimicrobial or granulocyte colony stimulating factor prophylaxis. Mortality was attributed to treatment in 19% of evaluable patients. Conclusion: The clinical efficacy and utility of IVAC +/- R remain unclear. However, its profound hematologic toxicity and life-threatening complications despite prophylactic measures warrant careful consideration of alternatives. (C) 2021 Elsevier Inc. All rights reserved. |
| Keywords: | chemotherapy; retrospective study; prophylaxis; drug toxicity; diffuse large b-cell lymphoma; regimen; burkitt-lymphoma |
| Journal Title: | Clinical Lymphoma, Myeloma and Leukemia |
| Volume: | 21 |
| Issue: | 12 |
| ISSN: | 2152-2650 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2021-12-01 |
| Start Page: | 873 |
| End Page: | 878 |
| Language: | English |
| ACCESSION: | WOS:000724142300016 |
| DOI: | 10.1016/j.clml.2021.07.024 |
| PROVIDER: | wos |
| PMCID: | PMC8643303 |
| PUBMED: | 34413005 |
| Notes: | Article -- Source: Wos |
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