Onkológia 1/2023

Pixantrone in the treatment of relapsed/refractory aggressive B-non Hodgkin›s lymphomas: a retrospective data analysis

Purpose: In a cohort of 16 patients, we evaluated the efficacy and tolerance of the new aza-anthracenedione pixantrone, which broadened the range of options for pretreated adult patients with aggressive refractory / relapsed B-non Hodgkin›s lymphoma category DLBCL (R/R DLBCL), already been treated with rituximab and are indicated for the third and next lines of treatment. Patients and methods: From 1.1.2015 to 1.1.2021, we have treated with pixantrone 16 patients with R/R DLBCL with a median age of 63.5 years (30-73), stage II disease 1 patient (6.25%), III. 2 patients (12.5%) and IV. 13 patients (81.25%) at the National Cancer Institute in Bratislava (NCI). Patients were pretreated with 2-7 lines (median 3), most often with R-CHOP regimen (75%), the majority 11 patients (68.75%) underwent 2-3 lines of chemotherapy. All of them had received anthracycline in the past, and except 1 case also rituximab. High-dose chemotherapy with autologous hematopoietic stem cell transplantation underwent 8 patients (50%) and allogeneic transplantation 2 patients (12.5%). Results: We compared the results of a retrospective analysis of the obtained data with the results of the international randomized study PIX-301 phase III. Full 6 cycles of pixantrone (18 administrations) were completed in 7 patients (43.75%), the median was 10 (2-18), treatment was terminated prematurely in 9 patients (56.25%), dose reduction was required in 4 patients (25%) and delays of administration in 12 patients (75% ). Complete remission (CR) was achieved in 5 patients (31.25%) and partial response (PR) in 1 patient (6.25%). Progression (PRO) on treatment was observed in 10 patients (62.5%). All treated had haematological toxicity, grade III. in 8 patients (50%) and grade IV. in 3 patients (18.75%). So far, 10 patients (62.5%) died of disease progression, 2 patients (12.5%) are alive with progression of the lymphoma, 1 patient (6.25%) remain in partial remission, and sustained complete response is observed in 3 patients (18.75%). The median overall survival (mOS) was 10.4 months (1.43-49.8) and the median progression-free survival (mPFS) was 3.5 months (0.47-31.13). Conclusion: Haematological toxicity was the only cause of dose reduction and prolongation of administration intervals. We did not observe cardiotoxicity in any patient. Pixantrone is a suitable alternative for the treatment of certain sort of patients with R/R DLBCL.

Keywords: pixantrone, relapsed/refractory aggressive lymphoma, pretreated patients, haematological toxicity, diffuse large B-cell lymphoma