What are the treatment recommendations for relapsed or refractory diffuse large B-cell lymphoma (DLBCL) prior to HDC-ASCT?

Updated: Jun 12, 2019
  • Author: Francisco J Hernandez-Ilizaliturri, MD; Chief Editor: Koyamangalath Krishnan, MD, FRCP, FACP  more...
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Answer

Answer

Patients eligible for HDC-ASCT (treatment goal = cure):

A vast number of regimens are used in the treatment of patients with relapsed or refractory DLBCL. These are primarily based on chemotherapy agents that are not cross-resistant to those used in the front-line setting, with or without rituximab. The goal of salvage regimens is to achieve maximum tumor burden cytoreduction in preparation for HDC with ASCT (HDC-ASCT). [10]

  • RICE: Rituximab 375 mg/m2 day 1 plus ifosfamide 5 g/m2 on day 2 plus carboplatin AUC 5 plus etoposide 100 mg/m2 daily on days 1-3; every 14 d [11] (see also the Carboplatin AUC Dose Calculation [Calvert formula] calculator) or

  • ICE: Ifosfamide 5 g/m2 on day 2 plus  carboplatin AUC 5 plus  etoposide 100 mg/ m2 daily on days 1-3; every 14d [12] or

  • GDP: Gemcitabine 1000 mg/m2 on days 1 and 8 plus  dexamethasone 40 mg on days 1-4 plus cisplatin 75 mg/m2 on day 1; every 21d [13]  or

  • GEM-P: Gemcitabine 1000 mg/m2 on days 1 and 8 plus methylprednisolone 1000 mg/m2 on days 1-5 plus  cisplatin 100 mg/m2 on day 15; every 28 d [14, 15] or

  • Gem-P: Gemcitabine 1000 mg/m2 on days 1 and 8 plus  cisplatin 100 mg/m2 on day 1; every 21d [16, 17] or

  • R+GEMOX: Rituximab 375 mg/m2 plus  gemcitabine 1000 mg/m2 plus oxaliplatin 100 mg/m2 on day 1; every 14 d [17] or

  • ESHAP: Etoposide 40 mg/m2/day plus  methylprednisolone 500 mg/day plus  cisplatin 25 mg/m2/day by continuous IV infusion (CIVI) for 4 d  plus cytarabine (Ara-C) 2 g/m2 on day 5 [18] or

  • DHAP: Dexamethasone 40 mg on days 1-4 plus  cytarabine 2 g/m2 every 12h for 2 doses on day 2 plus  cisplatin 100 mg/m2 on day 1; every 21d [19]  or

  • R-DHAP: Dexamethasone 40 mg on days 1-4 plus  cytarabine 2 g/m2 every 12h for 2 doses on day 2 plus  cisplatin 100 mg/m2 on day 3; every 21 d plus  rituximab 375 mg/m2 weekly for 4 wk starting on day 1 of first cycle [20] or

  • R-DHAP-VIM-DHAP: Cisplatin 100 mg/m2 on day 1 by continuous IV infusion plus  cytarabine 2 g/m2 every 12 h for 2 doses on day 2 plus  dexamethasone 40 mg/day on days 1-4; VIM = etoposide 90 mg/m2 on days 1, 3, and 5 plus  ifosfamide 1200 mg/m2 IV on days 1-5 plus  methotrexate 30 mg/m2 IV on days 1 and 5; rituximab 375 mg/m2 is administered on day 5 of the DHAP courses or on day 6 of the VIM course [21] or

  • DHAP-VIM-DHAP: Cisplatin 100 mg/m2 on day 1 by continuous IV infusion plus  cytarabine 2 g/m2 every 12 h for 2 doses on day 2 plus  dexamethasone 40 mg/day on days 1-4; VIM = etoposide 90 mg/m2 on days 1, 3, and 5 plus  ifosfamide 1200 mg/m2 IV on days 1-5 plus  methotrexate 30 mg/m2 IV on days 1 and 5 [21]

  • Polatuzumab vedotin 1.8 mg/kg IV on Day 1 plus  rituximab 375 mg/m2 IV on Day 1 plus  bendamustine 90 mg/m2/day on Days 1 and 2 every 21d for 6 cycles; may administer polatuzumab, bendamustine, and rituximab in any order on Day 1 of each cycle [22]


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