Rituximab and ICE as second-line therapy before autologous stem cell transplantation for relapsed or primary refractory diffuse large B-cell lymphoma Journal Article


Authors: Kewalramani, T.; Zelenetz, A. D.; Nimer, S. D.; Portlock, C.; Straus, D.; Noy, A.; O'connor, O.; Filippa, D. A.; Teruya-Feldstein, J.; Gencarelli, A.; Qin, J.; Waxman, A.; Yahalom, J.; Moskowitz, C. H.
Article Title: Rituximab and ICE as second-line therapy before autologous stem cell transplantation for relapsed or primary refractory diffuse large B-cell lymphoma
Abstract: Patients with relapsed or primary refractory diffuse large B-cell lymphoma (DLBCL) who achieve complete response (CR) before autologous stem cell transplantation (ASCT) generally have better outcomes than those who achieve only partial response (PR). We investigated whether adding rituximab to the ifosfamide-carboplatin-etoposide (ICE) chemotherapy regimen (RICE) could increase the CR rate of patients with DLBCL under consideration for ASCT. Thirty-six eligible patients were treated with RICE, and 34 received all 3 planned cycles. The CR rate was 53%, significantly better than the 27% CR rate (P = .01) achieved among 147 similar consecutive historical control patients with DLBCL treated with ICE; the PR rate was 25%. Febrile neutropenia was the most frequent grade 3 or 4 nonhematologic toxicity; It occurred in 7.5% of delivered cycles. No patient had RICE-related toxicity that precluded ASCT. The median number of CD34+ cells per kilogram mobilized was 6.3 × 106. Progression-free survival rates of patients who underwent transplantation after RICE were marginally better than those of 95 consecutive historical control patients who underwent transplantation after ICE (54% vs 43% at 2 years; P = .25). RICE appears to induce very high CR rates in patients with relapsed and refractory DLBCL; however, further studies are necessary to determine whether this treatment regimen will improve outcomes after ASCT. © 2004 by The American Society of Hematology.
Keywords: adolescent; adult; cancer survival; clinical article; treatment outcome; aged; middle aged; survival analysis; neutropenia; salvage therapy; doxorubicin; cytarabine; rituximab; carboplatin; infection; etoposide; nausea; thrombocytopenia; vomiting; antineoplastic combined chemotherapy protocols; cyclophosphamide; melphalan; vincristine; deep vein thrombosis; hematopoietic stem cell transplantation; carmustine; ifosfamide; febrile neutropenia; lung embolism; b cell lymphoma; lymphoma, b-cell; antibodies, monoclonal; paracetamol; cardiotoxicity; remission induction; granulocyte colony stimulating factor; antigens, cd34; transplantation, autologous; hemorrhagic cystitis; autologous hematopoietic stem cell transplantation; diphenhydramine; angina pectoris; pyrexia idiopathica; lymphoma, large-cell, diffuse; humans; human; priority journal; article
Journal Title: Blood
Volume: 103
Issue: 10
ISSN: 0006-4971
Publisher: American Society of Hematology  
Date Published: 2004-05-15
Start Page: 3684
End Page: 3688
Language: English
DOI: 10.1182/blood-2003-11-3911
PROVIDER: scopus
PUBMED: 14739217
DOI/URL:
Notes: Blood -- Cited By (since 1996):215 -- Export Date: 16 June 2014 -- CODEN: BLOOA -- Source: Scopus
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MSK Authors
  1. Joachim Yahalom
    394 Yahalom
  2. Carol Portlock
    178 Portlock
  3. Craig Moskowitz
    369 Moskowitz
  4. Ariela Noy
    204 Noy
  5. Julie T Feldstein
    288 Feldstein
  6. Jing Qin
    86 Qin
  7. Andrew D Zelenetz
    546 Zelenetz
  8. Stephen D Nimer
    339 Nimer
  9. Daniel A Filippa
    98 Filippa
  10. David J Straus
    205 Straus
  11. Alyson C Waxman
    1 Waxman