A New Salvage Regimen for Aggressive Lymphomas Based on Gemcitabine, Rituximab, and Oxaliplatin followed by Lenalidomide (GROC-Rev)

Abstract Background Our objective was to evaluate the impact of lenalidomide in patients with aggressive lymphoma who attained Methods Patients with relapsed/refractory non-Hodgkin lymphoma received up to 6 GROC courses: rituximab (IV 375 mg/m 2 ) day 1, oxaliplatin (IV 100 mg/m 2 ; 2 hours), gemcitabine (IV 1250 mg/m 2 IV; 30 min) on day 2, and pegfilgrastim (6 mg SC) on day 3. Patients switched to lenalidomide if they didn’t achieve at least PR after their second GROC course, or attained Results In 33 patients, overall response was 61% (CR=39%). Of 17 patients with PRs who continued to 6 courses, 10 (59%) attained CR and 7 PR as maximum response; of these 7, 1 died before lenalidomide, 1 achieved CR on lenalidomide (17%), and 2 a further PR (33%). Of 16 failing to respond to GROC after their second course, 2 died before lenalidomide, 2 had CR (14%) and 1 PR (7%) following lenalidomide. Overall survival and progression-free survival were 47% and 33% at 2 years. Grade 3-4 adverse events included neutropenia/thrombocytopenia/anemia (n = 5), neutropenic infection (n = 3), urinary tract infection (n = 3), pneumonia (n = 2), cellulitis (n = 2) and seizure (n = 1). Eight went on to receive transplant. Conclusion GROC-Rev is an effective and well-tolerated salvage regimen consisting of chemotherapy followed by lenalidomide maintenance in patients with R/R NHL. Simultaneous administration of these agents is worth exploring in future study.