What are the treatment recommendations for relapsed or refractory diffuse large B-cell lymphoma (DLBCL) in patients not eligible for 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 not eligible for HDC-ASCT (treatment goal = palliation):

  • GV: Gemcitabine 1000 mg/m2 plus vinorelbine 30 mg/m2 on days 1 and 8; every 21 d [26] or

  • GVP: Gemcitabine 1000 mg/m2 plus  vinorelbine 30 mg/m2 on days 1 and 8 plus  prednisone 100 mg on days 1-8; every 21d [27] or

  • ViGePP: Vinorelbine 25 mg/m2 plus  gemcitabine 800 mg/m2 on days 1 and 8 plus procarbazine 100 mg/m2 on days 1-7 plus  prednisone 60 mg/m2 on days 1-15; every 28 d [28] or

  • IEV: Ifosfamide 2500 mg/m2 plus  etoposide 150 mg/m2 on days 1-3 plus epirubicin 100 mg/m2 on day 1; every 21 d [28, 29] or

  • MINE: Ifosfamide 2660 mg/m2/day on days 1-3 plus  etoposide 300 mg/m2 in 1 dose on days 1-3; followed by ifosfamide 3300mg/m2 on days 1-3 plus mitoxantrone 20 mg/m2 on day 1 if less than complete response is achieved [30] or

  • IVAD: Ifosfamide 1500 mg/m2plus  etoposide 100 mg/m2plus  cytarabine 100 mg/m2plus  dexamethasone 40 mg on days 1-5; every 21d [31] or

  • Mini-BEAM: Busulfan 60 mg/m2 on day 1 plus  etoposide 75 mg/m2 on days 2-5 plus  cytarabine 100 mg/m2 every 12h on days 2-5 plus melphalan 30 mg/m2 on day 6; every 28d [32, 33] or

  • EPOCH: Doxorubicin 10 mg/m2 plus  etoposide 50 mg/m2 plus  vincristine 0.4 mg/m2 by continuous IV infusion on days 2-4 plus  cyclophosphamide 750 mg/m2 on day 6 plus  prednisone 60 mg/m2 on days 1-6; every 21 d [34] or

  • R-EPOCH: Rituximab 375 mg/m2 IV on day 1 plus  doxorubicin 15 mg/m2 plus  etoposide 65 mg/m2 plus  vincristine 0.5 mg/day by continuous IV infusion on days 2-4 plus  cyclophosphamide 750 mg/m2 on day 5 plus  prednisone 60 mg/m2 on days 1-14; every 21d [35] or

  • Lenalidomide 25 mg PO on days 1-21; every 28 d until progression or unacceptable toxicity [36]


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