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1740 The Addition of Lenalidomide to R-CHOP Is Effective for Prevention of CNS Relapse in High-Risk Patients with Diffuse Large B-Cell Lymphoma

Program: Oral and Poster Abstracts
Session: 627. Aggressive Lymphomas: Pharmacologic Therapies: Poster I
Hematology Disease Topics & Pathways:
Research, Clinical trials, Clinical Research
Saturday, December 7, 2024, 5:30 PM-7:30 PM

Xiaolei Wei, MD1*, Xutao Guo, MD2*, Qi Wei, MD3*, Dan Xiong, MD & PhD4*, Peng Zhang5*, Zewen Zhang6*, Yongqiang Wei, MD1* and Ru Feng7*

1Department of Hematology, Nanfang Hospital of Southern Medical University, Guangzhou, China
2Nanfang Hospital, GUANGZHOU, GUANGDONG, China
3Guangzhou Dadao North Street NO. 1838, Guangzhou, Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangzhou, China
4Department of Hematology, Shunde Hospital, Southern Medical University, Guangzhou, China
5Department of Hematology, General Hospital of Southern Theater Command, Guangzhou, China
6Department of Hematology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
7Department of Hematology, Nanfang Hospital of Southern Medical University, Guangzhou, China, Guangdong, China

Central nervous system (CNS) relapse is an uncommon but devastating event in patients in diffuse large B-cell lymphoma (DLBCL). Although several prophylaxis attempts including intrathecal methotrexate and intravenous high-dose methotrexate were conducted to reduce the CNS relapse rate, the optimal management remained uncertain. Herein, we performed an open-label, multicenter trial to explore the efficacy and safety of the combination of lenalidomide and R-CHOP (R2-CHOP) for preventing the CNS relapse in the high-risk diffuse large B cell lymphoma.

Eligible patients were aged 18–80 years, newly diagnosed DLBCL and high risk for CNS recurrence: CNS-IPI:4-6 or involvement of testicular, kidneys or adrenal glands. Lenalidomide orally 25 mg per day was administered on days 1 through 10 of each cycle and delivered concomitantly with standard dose R-CHOP-21 regimen. All patients received aspirin 100mg per day prophylaxis throughout. The primary endpoint was 2-year central nervous system relapse rates. The secondary endpoint were 2-year overall survival, progression-free survival, and treatment-emergent adverse events. This trial is registered with ClinicalTrials.gov, number NCT04544059.

A total of 64 DLBCL patients with high-risk for CNS relapse were included in this study and 56 of them was evaluated. The median age of the patients in this study was 57 years old (range 26–77) and 48.2% patients were female. 91.1% patients had a CNS-IPI score ≥4 and the left patients may be involved with testicular, kidneys or adrenal glands. With a median follow up of 20 months, only 2 (3.6%) patient developed CNS relapse. The 2-year progression-free survival and overall survival were 77.8% and 79.7%, respectively.

In summary, lenalidomide with R-CHOP is effective for prevention of CNS relapse in high-risk patients with diffuse large B-cell lymphoma.

Keywords:

Diffuse large B-cell lymphoma, central nervous system relapse, lenalidomide.

Disclosures: No relevant conflicts of interest to declare.

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