Combination of Decitabine and a Modified Regimen of Cisplatin, Cytarabine and Dexamethasone: A Potential Salvage Regimen for Relapsed or Refractory Diffuse Large B-Cell Lymphoma After Second-Line Treatment Failure

Junxia Hu; Xin Wang; Fei Chen; Mengjie Ding; Meng Dong; Wanqiu Yang; Meifeng Yin; Jingjing Wu; Lei Zhang; Xiaorui Fu; Zhenchang Sun; Ling Li; Xinhua Wang; Xin Li; Shuangshuang Guo; Dianbao Zhang; Xiaohui Lu; Qing Leng; Mingzhi Zhang; Linan Zhu; Xudong Zhang; Qingjiang Chen

doi:10.3389/fonc.2021.687374

Combination of Decitabine and a Modified Regimen of Cisplatin, Cytarabine and Dexamethasone: A Potential Salvage Regimen for Relapsed or Refractory Diffuse Large B-Cell Lymphoma After Second-Line Treatment Failure

Front Oncol. 2021 Jun 18:11:687374. doi: 10.3389/fonc.2021.687374. eCollection 2021.

Authors

Junxia Hu¹, Xin Wang¹, Fei Chen², Mengjie Ding¹, Meng Dong¹, Wanqiu Yang³, Meifeng Yin¹, Jingjing Wu¹, Lei Zhang¹, Xiaorui Fu¹, Zhenchang Sun¹, Ling Li¹, Xinhua Wang¹, Xin Li¹, Shuangshuang Guo⁴, Dianbao Zhang⁴, Xiaohui Lu⁵, Qing Leng⁶, Mingzhi Zhang¹, Linan Zhu¹, Xudong Zhang¹, Qingjiang Chen¹

Affiliations

¹ Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
² Medical School, Queen Mary School, Nanchang University, Nanchang, China.
³ Department of Oncology, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China.
⁴ Department of Oncology, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China.
⁵ Lymphoma Hematopoietic Stem Cell Transplantation Center of the People's Hospital of Jiaozuo City, Jiaozuo, China.
⁶ Department of Hematology, Anshan Central Hospital, Anshan, China.

Abstract

Objective: The prognosis for patients with relapsed or refractory diffuse large B-cell lymphoma (R/R-DLBCL) after second-line treatment failure is extremely poor. This study prospectively observed the efficacy and safety of decitabine with a modified cisplatin, cytarabine, and dexamethasone (DHAP) regimen in R/R-DLBCL patients who failed second-line treatment.

Methods: Twenty-one R/R-DLBCL patients were enrolled and treated with decitabine and a modified DHAP regimen. The primary endpoints were overall response rate (ORR) and safety. The secondary endpoints were progression-free survival (PFS) and overall survival (OS).

Results: ORR reached 50% (complete response rate, 35%), five patients (25%) had stable disease (SD) with disease control rate (DCR) of 75%. Subgroup analysis revealed patients over fifty years old had a higher complete response rate compared to younger patients (P = 0.005), and relapsed patients had a better complete response rate than refractory patients (P = 0.031). Median PFS was 7 months (95% confidence interval, 5.1-8.9 months). Median OS was not achieved. One-year OS was 59.0% (95% CI, 35.5%-82.5%), and two-year OS was 51.6% (95% confidence interval, 26.9%-76.3%). The main adverse events (AEs) were grade 3/4 hematologic toxicities such as neutropenia (90%), anemia (50%), and thrombocytopenia (70%). Other main non-hematologic AEs were grade 1/2 nausea/vomiting (40%) and infection (50%). No renal toxicity or treatment-related death occurred.

Conclusion: Decitabine with a modified DHAP regimen can improve the treatment response and prognosis of R/R-DLBCL patients with good tolerance to AEs, suggesting this regimen has potential as a possible new treatment option for R/R-DLBCL patients after second-line treatment failure.

Clinical trial registration: ClinicalTrials.gov, identifier: NCT03579082.

Keywords: chemotherapy; decitabine; diffuse large B cell lymphoma; modified DHAP regimen; safety.

Associated data

ClinicalTrials.gov/NCT03579082