Michael J Buege1, Phuong H Dao2, Esther Drill3, Andréa LeVoir2, Terry Pak2, Tim J Peterson2, David J Straus4. 1. Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: buegem@mskcc.org. 2. Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY. 3. Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY. 4. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
Abstract
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.
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.
Authors: Michael Crump; Sattva S Neelapu; Umar Farooq; Eric Van Den Neste; John Kuruvilla; Jason Westin; Brian K Link; Annette Hay; James R Cerhan; Liting Zhu; Sami Boussetta; Lei Feng; Matthew J Maurer; Lynn Navale; Jeff Wiezorek; William Y Go; Christian Gisselbrecht Journal: Blood Date: 2017-08-03 Impact factor: 22.113
Authors: Mark Roschewski; Kieron Dunleavy; Jeremy S Abramson; Bayard L Powell; Brian K Link; Prapti Patel; Philip J Bierman; Deepa Jagadeesh; Ronald T Mitsuyasu; David Peace; Peter R Watson; Wahid T Hanna; Christopher Melani; Andrea N Lucas; Seth M Steinberg; Stefania Pittaluga; Elaine S Jaffe; Jonathan W Friedberg; Brad S Kahl; Richard F Little; Nancy L Bartlett; Michelle A Fanale; Ariela Noy; Wyndham H Wilson Journal: J Clin Oncol Date: 2020-05-26 Impact factor: 44.544