Efficacy of RICE as Second Line Chemotherapy in Transplant Ineligible Patients with Diffuse Large B Cell Lymphoma: a Single Institution Experience.

The response of patients with relapse/refractory (s/p CHOPR) Diffuse large B Cell Lymphoma (DLBCL) to RICE chemotherapy in transplant ineligible patients (pts) is not well studied.

28 consecutive pts with DLBCL, relapsed/refractory to CHOPR chemotherapy diagnosed in 2003 to 2008 were studied as a retrospective cohort for clinical presentation, prognostic characteristics and long term survival. Prognostic characteristics and survival was analyzed using fisher's exact test, exact logistic regression and Kaplan Meier analysis. Multiple imputation methods were used for missing data.

28 pts, 11(39%) were female, 17(61%) male. 11 (39.3%) African Americans, 12 (42.9%) Hispanic, 3 (11%) Caucasian and 2 (7%) Asians. 3 (10.7%) presented with stage I at diagnosis, 1(3.6%) stage II, 5(17.9%) stage III and 19 (67.9%) stage IV. The median age at diagnosis was 50.5 years (yrs) (22-71). 4 (14.3%) presented with stage I, 5(17.9%) stage II, 9(32.1%) stage III, 10(35.7%) stage IV. 14(50%) had intermediate risk Revised IPI score, 14 (50%) had high risk disease at presentation.

21(75%) had relapse and 7(25%) had refractory disease. Median time to relapse was 12 months (0-40). Median age at relapse was 51.5 yrs (23-72). 4 (14.3%) presented with stage I at relapse, 5 (17.9%) stage II, 9(32.1%) stage III and 10 (35.7%) stage IV. 12(42.8%) had intermediate risk R-IPI score at relapse and 16(57.2%) had high risk R-IPI score. The median follow up was 30 months (8-60).

All patients received first line therapy with CHOPR 6-8 cycles. RICE was used as second line therapy. Median number of cycles was 4 (1-7). 10 (35.7%) had a complete response. 13 (46.4%) had partial response and 5 (17.9%) had progression of disease. Disease free survival was 10 months (0-55). Median overall survival was 30.5 months (8-60). There was no treatment related mortality.

Extra nodal involvement (p=0.0094) was the only factor that significantly influenced response to RICE chemotherapy. Race (p=0.081) had boarder line significance with African American having poor response compared to other race. Pt with relapsed disease (p=0.013) and extra nodal involvement at relapse (p=0.049) had better disease free survival. The LDH at presentation (p=0.012), no extra nodal involvement at presentation (p=0.004), relapsed disease (p=0.048) and CR to RICE (0.001) significantly influenced overall survival.

In transplant ineligible patients with relapsed/refractory Diffuse Large B Cell Lymphoma, RICE can be considered as a second line therapy with a response rate of over 80%. The median disease free survival was 10 months, overall survival was 30.5 months. Pt with lower LDH and chemo sensitive disease had better over all survival. Poor response of African Americans to second line chemotherapy needs to be further investigated.

No relevant conflicts of interest to declare.