These authors contributed equally.
Original Research Article
Salvage chemoimmunotherapy with rituximab, ifosfamide and etoposide (R-IE regimen) in patients with primary CNS lymphoma relapsed or refractory to high-dose methotrexate-based chemotherapy†
Article first published online: 14 NOV 2012
Copyright © 2012 John Wiley & Sons, Ltd.
Volume 31, Issue 3, pages 143–150, September 2013
How to Cite
Mappa, S., Marturano, E., Licata, G., Frezzato, M., Frungillo, N., Ilariucci, F., Stelitano, C., Ferrari, A., Sorarù, M., Vianello, F., Baldini, L., Proserpio, I., Foppoli, M., Assanelli, A., Reni, M., Caligaris-Cappio, F. and Ferreri, A. J. M. (2013), Salvage chemoimmunotherapy with rituximab, ifosfamide and etoposide (R-IE regimen) in patients with primary CNS lymphoma relapsed or refractory to high-dose methotrexate-based chemotherapy. Hematol. Oncol., 31: 143–150. doi: 10.1002/hon.2037
Preliminary results have been presented as poster at the 16th Annual Meeting of the European Hematology Association, London, UK, 2011; and published in abstract form as Marturano E., Licata G., Donadoni G., et al. Salvage chemotherapy with rituximab, ifosfamide and etoposide (R-IE) in patients with primary CNS lymphoma relapsed or refractory to high-dose methotrexate-based chemotherapy. Haematologica 96 (2): abstract# 380, 2011.
- Issue published online: 30 OCT 2013
- Article first published online: 14 NOV 2012
- Manuscript Accepted: 5 OCT 2012
- Manuscript Revised: 3 OCT 2012
- Manuscript Received: 2 AUG 2012
- primary CNS lymphoma;
- autologous stem cell transplantation
Despite a high proportion of patients with primary CNS lymphoma (PCNSL) experiences failure after/during first-line treatment, a few studies focused on salvage therapy are available, often with disappointing results. Herein, we report feasibility and activity of a combination of rituximab, ifosfamide and etoposide (R-IE regimen) in a multicentre series of patients with PCNSL relapsed or refractory to high-dose methotrexate-based chemotherapy. We considered consecutive HIV-negative patients ≤75 years old with failed PCNSL treated with R-IE regimen (rituximab 375 mg/m2, day 0; ifosfamide 2 g/m2/day, days1–3; etoposide 250 mg/m2, day 1; four courses). Twenty-two patients (median age 60 years; range 39–72; male/female ratio: 1:4) received R-IE as second-line (n = 18) or third-line (n = 4) treatment. Eleven patients had refractory PCNSL, and 11 had relapsing disease. Twelve patients had been previously irradiated. Sixty (68%) of the 88 planned courses were actually delivered; only one patient interrupted R-IE because of toxicity. Grade 4 hematological toxicity was manageable; a single case of grade 4 non-hematological toxicity (transient hepatotoxicity) was recorded. Response was complete in six patients and partial in three (overall response rate = 41%; 95%CI: 21–61%). Seven patients were successfully referred to autologous peripheral blood stem cell collection; four responders were consolidated with high-dose chemotherapy supported by autologous stem cell transplant. At a median follow-up of 24 months, eight responders did not experience relapse, two of them died of neurological impairment while in remission. Six patients are alive, with a 2-year survival after relapse of 25 ± 9%. We concluded that R-IE is a feasible and active combination for patients with relapsed/refractory PCNSL. This regimen allows stem cell collection and successful consolidation with high-dose chemotherapy and autologous transplant. Copyright © 2012 John Wiley & Sons, Ltd.