Rituximab-Lenalidomide-Ibrutinib Combination for Relapsed/Refractory Primary CNS Lymphoma
Caroline Houillier, Cécile Moluçon‐Chabrot, Marie‐Pierre Moles‐Moreau, Lise Willems, Guido Ahle, Agathe Waultier‐Rascalou, Luc‐Matthieu Fornecker, Khê Hoang‐Xuan, Carole Soussain
Abstract
<h3>Background and Objectives</h3> To evaluate the efficacy and tolerance of the association rituximab-lenalidomide-ibrutinib (R<sup>2</sup>I) in relapsed/refractory (R/R) primary CNS lymphoma (PCNSL). <h3>Methods</h3> R/R PCNSL patients treated with R<sup>2</sup>I were retrospectively selected and analyzed from the French LOC database. <h3>Results</h3> Fourteen patients (median age: 63 years, median Karnofsky Performance Status: 75%) received R<sup>2</sup>I, administered after a median of 2 previous lines of chemotherapy, including autologous stem cell transplantation (ASCT) in 5 cases. The best response was complete response in 4/14 patients and partial response in 4/14 patients, achieved in a median of 2.5 months. Three responder patients received consolidation treatment (WBRT: N = 2, ASCT: N = 1) after R<sup>2</sup>I, and R<sup>2</sup>I served as a bridge before CAR-T cell therapy for one patient. R<sup>2</sup>I was discontinued due to toxicity in 3/14 patients. There were no toxicity-related deaths. <h3>Discussion</h3> The R<sup>2</sup>I combination resulted in a high rate of response of rapid-onset in heavily pretreated patients with poor prognosis, with manageable toxicity, and allowed 3 patients to proceed to consolidation. Although preliminary, these results support the use of R<sup>2</sup>I for R/R PCNSL failing conventional chemotherapies. <h3>Classification of Evidence</h3> This study provides Class IV evidence that combination of rituximab-lenalidomide-ibrutinib induces a high rate of response in heavily pretreated R/R PCNSL.