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

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/m²plus gemcitabine 1000 mg/m²plus 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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