Complete response to pixantrone as a salvage therapy in a relapsed/refractory diffuse large B-cell lymphoma

Abstract

Diffuse large B-cell lymphoma (DLBCL) is an aggressive form of non-Hodgkin lymphoma (NHL). It is one of the most common form of the disease. A combination of chemotherapy with anthracycline and a monoclonal antibody targeting CD20 is used as a I line therapy. About two out of three people with DLBCL achieve and maintain complete remission after this treatment. In case of relapse or refractory disease a salvage high-dose chemotherapy followed by autologous stem cell transplantation (HD-ASCT) is the standard of care. Patientrs who relapse after HD-ASCT have a very poor prognosis. Pixantrone is a new anthracycline derivative registered to treat relapsed/refractory DLBCL in adult patients. It is a cytostatic agent with a reduced cardiotoxicity comparing to classic anthracyclines. Herein, we report two cases of relapsed/refractory DLBCL treated with pixantrone as a salvage therapy. The first case concernes a 58-year-old female patient with a diagnose of DLBCL, who relapsed after four prior lines of therapy (R-CHOP, ICE, HD-Mtx, CSN radiation) and achieved complete remission after pixantrone therapy, but died of acute myeloid leukemia 3 months after the end of treatment. Second case is a story of a 75-year-old female patient treated with two prior lines of treatment (R-CHOP, R-IVE), who achieved complete remission after a III line of therapy with pixantrone. Pixantrone monotherapy proves to be effective in relapsed/refractory DLBCL. This treatment is well tolerated in a group of elderly patients and can be also used in a group of patients with a limited cardiac function.