1003PD - A Multicentre Phase II Trial addressing Lenalidomide (LEN) Maintenance in Patients with Relapsed Diffuse Large B-Cell Lymphoma (rDLBCL) who are not...

Date 11 September 2017
Event ESMO 2017 Congress
Session Haematological malignancies
Topics Lymphomas
Haematologic Malignancies
Presenter Marianna Sassone
Citation Annals of Oncology (2017) 28 (suppl_5): v355-v371. 10.1093/annonc/mdx373
Authors M. Sassone1, F. Zaja2, A. Re3, M. Spina4, A. Di Rocco5, A. Fabbri6, C. Stelitano7, M. Frezzato8, C. Rusconi9, R. Zambello10, T. Calimeri1, L. Scarfò1, C. Cecchetti1, M. Chiozzotto11, M. Ponzoni12, A. Ferreri1
  • 1Unit Of Lymphoid Malignancies, Department Of Oncohematology, IRCCS San Raffaele, 20132 - Milan/IT
  • 2Hematology Unit, University of Udine, 3310033100 - Udine/IT
  • 3Hematology Unit, spedali civili di brescia, 25123 - brescia/IT
  • 4Hematology Unit, Centro di Riferimento Oncologico, 33081 - Aviano/IT
  • 5Hematology Unit, University La Sapienza, 00198 - Roma/IT
  • 6Hematology Unit, University of Siena, 53100 - Siena/IT
  • 7Hematology Unit, A.O. Melacrino-Morelli, 89121 - Reggio Calabria/IT
  • 8Hematology Unit, San bortolo Hospital, 36100 - Vicenza/IT
  • 9Hematology Unit, Niguarda Hospital, 20121 - Milano/IT
  • 10Hematology Unit, University of Padova, 35121 - Padova/IT
  • 11Hematology Unit, AO Udine, 3310033100 - Udine/IT
  • 12Haematopathology Diagnostic Area- Pathology Unit, IRCCS San Raffaele, 20132 - Milan/IT

Abstract

Background

Single-drug maintenance after salvage therapy could prolong survival of pts with rDLBCL not eligible to ASCT. LEN could be an excellent candidate as it is an oral agent, active against DLBCL, with excellent safety profile. Herein, we report results of a multicentre phase II trial addressing LEN maintenance (mLEN) in pts with chemosensitive rDLBCL.

Methods

HIV-negative pts with DLBCL relapsed after R-CHOP or similar and responsive to salvage therapy were registered and treated with LEN 25 mg/day for 21 days out of 28 until lymphoma failure or unacceptable toxicity. Primary endpoint was the 1-year PFS. Estimated sample size (Simon's two-stage optimal design; type I error 5%, power 80%, P0 30%, P1 50%) was 47 pts; mLEN would be considered effective if ≥ 19 pts will be progression-free survivors at 1 year. The prognostic role of cell of origin, assessed by NanoString and Hans algorithm, was investigated.

Results

46 of 48 enrolled pts were assessable (median age 72 years; 34-86); 26 pts started mLEN in CR and 20 in PR after salvage therapy. 639 LEN courses were delivered, with an average of 14 courses/pt (3-53). LEN was well tolerated: with the exception of neutropenia, grade 3-4 toxicities were uncommon (≤3% of courses). LEN dose reduction was indicated in 25 pts. Three pts died of toxicity: intestinal infarction, meningitis, unknown cause; 2 pts developed a second cancer. The pre-determined efficacy threshold (n ≥ 19) was largely achieved: 32 pts were progression free at 1 year from registration. At a median follow-up of 38 (14-95) months, 23 events occurred: PD in 19 pts, death of toxicity in 3, death while off therapy in 1, with a 1-yr PFS of 70% (95%CI=59-81). The benefit of mLEN was observed both in pts with de novo or transformed DLBCL, and both in GCB- or nonGCB-DLBCL. 29 (63%) pts are alive, with a 3-yr OS of 64%.

Conclusions

With the limitations of a non-randomized design, this trial soundly promotes the use of mLEN in pts with chemosensitive rDLBCL not eligible for ASCT or experiencing relapse after ASCT. These results warrant further investigation of immunomodulatory drugs as maintenance in these high-risk pts.

Clinical trial identification

NCT00799513

Legal entity responsible for the study

IRCCS San Raffaele

Funding

None

Disclosure

All authors have declared no conflicts of interest.