Lenalidomide and Rituximab Combined with CEP Chemotherapy (R2CEP) for Patients with Relapsed or Refractory B-Cell Lymphoma
Authors: Guidez Stephanie , Gruchet Cécile , Franques Paul , Darras Claire , Bobin Arthur , Tomowiak Cecile , Machet Antoine , Princet Isabelle , Leleu Xavier , Delwail Vincent 
Published: October 2019

Abstract
Background. Patients with relapse or refractory (R/R) B-cell Non Hodgkin Lymphoma (B-NHL), especially DLBCL, have a poor prognostic in relation to the mechanisms of resistance but also the lack of treatment options. This unmet medical need status is even more obvious in patients relapsing after intensive chemotherapy or frail patients, often non qualifying for clinical trial. Recently, the combination of lenalidomide and rituximab (R2) has proved of great interest in B-cell lymphoma. We therefore sought to combine R2 to conventional chemotherapy in advanced and frail R/R B-NHL in an unmet medical need status with a disastrous prognosis.
Method. Thirteen B-NHL were treated with R²CEP regimen with a median age of 82 years (58-92) and a median of 2 prior lines of treatment (1-4), 11 of them presented with advanced stage (III-IV) at relapse. Eleven patients were of DLBCL including 1 transformed follicular, along with 1 MCL and 1 FL. Patients had received an average of 2 prior lines of treatment (1-4) and presented for 11 of them an advanced stage (III-IV) at relapse. Patients were treated by R²CEP association with: rituximab 375mg/m² D1, cyclophosphamide 750mg/m² D1, etoposide 100mg/m² D1, prednisone 50mg/m² D1 to D5 and lenalidomide 10mg by day D1 to D14, 21-days cycles for 6 cycles of treatment.
Results. After a median follow-up of 7 months (0.5-13.2), 5 patients are still being treated, 2 have progressed upon treatment and one patient died of lymphoma progression. Overall, the CR rate is 54%. The projected overall survival rate at one year is 70%. Interestingly, the safety profile of this regimen was very appealing given the advanced and frail status of the patients recruited into this study. Indeed, although all patients experienced short pancytopenia, only one patient experienced an episode of febrile neutropenia grade 3.
Conclusion. In patients with advanced R/R DLBCL and frail condition, the combination of lenalidomide-rituximab and CEP chemotherapy seems well tolerated and provided an effective therapeutic option with greater than 50% of the patients possibly cured. The results will be updated for the congress.

Disclosures
Leleu: Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Incyte: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Karyopharm: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Merck: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Mundipharma: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Gilead: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; BMS: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Abbvie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees.