POSTER'22'
LENALIDOMIDE'MONOTHERAPY'IN'GERMINAL'CENTER'B'CELL'
RELAPSED/REFRACTORY'DIFFUSE'LARGE'BICELL'LYMPHOMA'SUBTYPE'–'
REPORT'OF'2'CASES'
'
Sara! Duarte1,! Adriana! Roque2,3,! Lenka! Ruzickova1,! Marília! Gomes1,! José! Pedro! Carda1,2!and! Letícia!
Ribeiro1!
!
(1)Hematology! Department,! Coimbra! Hospital! and! University! Centre! (CHUC),! Coimbra,! Portugal,!
(2)Faculty! of! Medicine! of! University! of! Coimbra,! Coimbra,! Portugal,! (3)Clinical! Haematology!
Department,!Centro!Hospitalar!e!Universitário!de!Coimbra!(CHUC),!Coimbra,!Portugal!
!
Background!Diffuse! large! BJcell! lymphoma! (DLBCL)! is! the! most! common! nonJHodgkin!
lymphoma!in!Western!countries.!Despite!great!clinical!improvements!brought!by!rituximab!
and! anthracycline! based! regimens! (RJCHOP),! 20J25%! of! patients! will! develop!
relapsed/refractory! (R/R)! disease! that! remains! a! major! cause! of! morbidity! and! mortality.!
Previous!studies!showed!improved!clinical!benefit!of!lenalidomide!monotherapy!in!patients!
with! R/R! DLBCL! of! the! nonJgerminal! center! B! cell! (GCB)! subtype,! when! compared! to! GCB!
subtype.!
Objectives'To! report! the! experience! of! our! department! in! treating! patients! with! GCB! R/R!
DLBCL!subtype!with!lenalidomide!monotherapy.!
Methods!Retrospective! analysis! of! 2! patients! with! GCB! R/R! DLBCL! subtype! treated! with!
lenalidomide!monotherapy.!
Results'Patient!1:!63JyearJold!male,!ECOGJPS!0,!diagnosed!with!DLBCL,!GCB!subtype,!stage!
IVJA,! IPI! highJrisk.! Two! chemoimmunotherapy! regimens! were! administered! prior! to!
lenalidomide! firstJline! RJCHOP,! achieving! complete! response! (CR)! durable! for! 2! years;!
second!line!regimen!including!rituximab!plus!gemcitabine,!relapsed!1!year!later.!Patient!was!
not! considered! candidate! for! autologous! stem! cell! transplantation! (ASCT)! due! to! cardiac!
toxicity!from!anthracycline.!
Patient!2:!46JyearJold!female,!ECOGJPS!0,!diagnosis!of!DLBCL,!GCB!subtype,!stage!IVJA,!IPI!
lowJrisk.!Refractory!to!first!and!second!lines!of!systemic!chemotherapy!(RJCHOP!and!DHAP).!
CR!to!third!line!treatment!with!ICE!regimen!plus!gastrectomy!for!persistent!localized!disease,!
therefore! submitted! to! BEAM! followed! by! ASCT.! Disease! relapsed! <1! year! after! ASCT! and!
patient!initiated!lenalidomide!monotherapy.!
To!date,!patient!1!received!30!cycles!and!patient!2,!32!cycles!of!lenalidomide!(for!21!days,!of!
28! days! cycle).! Patients! are! both! alive,! presenting! a! median! overall! survival! of! 36! months.!
Patient! 1! achieved! stable! disease! and! patient! 2! CR,! as! assessed! by! PET/CT! scans! and!
according!to!Lugano!criteria.!
Both! patients! required! ≥1! cycle! interruption! for! adverse! events! (AE).! The! most! frequent!
hematologic! AE! with! lenalidomide! was! neutropenia,! manageable! with! granulocyteJcolony!
stimulating! factor! (GJCSF)! administration.! Patient! 2! developed! non! transfusion! dependent!
anaemia,! improved! with! recombinant! erythropoietin! treatment.! NonJsevere! infectious!
complications! were! seen! in! both! cases.! Patient! 2! additionally! reported! fatigue,!
gastrointestinal!disorders!(mainly!constipation)!and!hypokalemia.!
Conclusions!Our! report! shows,! unexpectedly,! a! striking! clinical! benefit! of! lenalidomide!
monotherapy! in! R/R! DLBCL! patients,! albeit! GCB! subtype.! Despite! the! common! AE! of!
neutropenia! and! correlated! infectious! complications,! implicating! colony! stimulating! factor!
SCIENTIFIC PROGRAMME
SESSION I
HODGKIN’S DISEASE
DEBATE I
IS THERE STILL A ROLE
FOR COMBINED MODALITY
THERAPY FOR EARLY
STAGE CHL?
SESSION II
T-CELL LYMPHOMA
ROUNDTABLE I
FUTURE DIRECTIONS IN
T-CELL LYMPHOMA
SESSION III
FOLLICULAR LYMPHOMA
DEBATE II
CAN WE AVOID
CHEMOTHERAPY IN
THE MANAGEMENT OF
FOLLICULAR LYMPHOMA?
SESSION IV
RARE LYMPHOMAS –
MARGINAL ZONE
LYMPHOMA AND
WALDENSTRÖM M
ACROGLOBULINEMIA
ROUNDTABLE II – WHERE
TO GO IN RARE B-CELL
LYMPHOMAS
SESSION V
MANTLE CELL LYMPHOMA
SESSION VI
DIFFUSE LARGE B-CELL
LYMPHOMA
DEBATE III
DO WE STILL NEED ASCT
IN MCL?
SESSION VII
NOVEL THER APEUTIC
CONCEPTS IN B-CELL
LYMPHOMAS
SELECTED ABSTRACTS
FOR AN ORAL
PRESENTATION
SELECTED ABSTRACTS
FOR A POSTER
PRESENTATION
DISCLOSURES