Difference between revisions of "Anaplastic large cell lymphoma"
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!style="width: 50%"|Study | !style="width: 50%"|Study | ||
!style="width: 50%"|[[Levels_of_Evidence#Evidence|Evidence]] | !style="width: 50%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
+ | |- | ||
+ | |[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3731651/ Gopal et al. 2012 (SGN35-006)] | ||
+ | |style="background-color:#ffffbe"|Phase II, <20 pts in subgroup | ||
|- | |- | ||
|[http://jco.ascopubs.org/content/30/18/2190.long Pro et al. 2012 (SG035-0004)] | |[http://jco.ascopubs.org/content/30/18/2190.long Pro et al. 2012 (SG035-0004)] | ||
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|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3659993/ Gibb et al. 2012] | |[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3659993/ Gibb et al. 2012] | ||
|style="background-color:#91cf61"|Named Patient Programme | |style="background-color:#91cf61"|Named Patient Programme | ||
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− | ''Note: | + | ''Note: SGN35-006 is a re-treatment trial; all patients were previously exposed to brentuximab vedotin. Patients who had received the 1.2 mg/kg dose on a prior trial also received that dose at re-treatment.'' |
====Chemotherapy==== | ====Chemotherapy==== | ||
*[[Brentuximab vedotin (Adcetris)]] 1.8 mg/kg IV over 30 minutes on day 1 | *[[Brentuximab vedotin (Adcetris)]] 1.8 mg/kg IV over 30 minutes on day 1 | ||
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===References=== | ===References=== | ||
+ | # '''SGN35-006:''' Gopal AK, Ramchandren R, O'Connor OA, Berryman RB, Advani RH, Chen R, Smith SE, Cooper M, Rothe A, Matous JV, Grove LE, Zain J. Safety and efficacy of brentuximab vedotin for Hodgkin lymphoma recurring after allogeneic stem cell transplantation. Blood. 2012 Jul 19;120(3):560-8. Epub 2012 Apr 17. [http://bloodjournal.hematologylibrary.org/content/120/3/560.long link to original article] '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3731651/ link to PMC article] [https://www.ncbi.nlm.nih.gov/pubmed/22510871 PubMed] | ||
+ | ## '''Update:''' Bartlett NL, Chen R, Fanale MA, Brice P, Gopal A, Smith SE, Advani R, Matous JV, Ramchandren R, Rosenblatt JD, Huebner D, Levine P, Grove L, Forero-Torres A. Retreatment with brentuximab vedotin in patients with CD30-positive hematologic malignancies. J Hematol Oncol. 2014 Mar 19;7:24. [http://jhoonline.biomedcentral.com/articles/10.1186/1756-8722-7-24 link to original article] '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3994656/ link to PMC article] [https://www.ncbi.nlm.nih.gov/pubmed/24642247 PubMed] | ||
# '''SG035-0004:''' Pro B, Advani R, Brice P, Bartlett NL, Rosenblatt JD, Illidge T, Matous J, Ramchandren R, Fanale M, Connors JM, Yang Y, Sievers EL, Kennedy DA, Shustov A. Brentuximab vedotin (SGN-35) in patients with relapsed or refractory systemic anaplastic large-cell lymphoma: results of a phase II study. J Clin Oncol. 2012 Jun 20;30(18):2190-6. Epub 2012 May 21. [http://jco.ascopubs.org/content/30/18/2190.long link to original article] '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/22614995 PubMed] | # '''SG035-0004:''' Pro B, Advani R, Brice P, Bartlett NL, Rosenblatt JD, Illidge T, Matous J, Ramchandren R, Fanale M, Connors JM, Yang Y, Sievers EL, Kennedy DA, Shustov A. Brentuximab vedotin (SGN-35) in patients with relapsed or refractory systemic anaplastic large-cell lymphoma: results of a phase II study. J Clin Oncol. 2012 Jun 20;30(18):2190-6. Epub 2012 May 21. [http://jco.ascopubs.org/content/30/18/2190.long link to original article] '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/22614995 PubMed] | ||
## '''Update: Abstract:''' Barbara Pro, MD, Ranjana Advani, MD, Pauline Brice, MD, Nancy L. Bartlett, MD, Joseph D. Rosenblatt, MD, Tim Illidge, Jeffrey Matous, MD, Radhakrishnan Ramchandern, MD, Michelle A. Fanale, MD, Joseph M. Connors, MD, Yinghui Wang, MS, Dirk Huebner, MD, Dana A. Kennedy, PharmD, BCOP and Andrei R. Shustov, MD. Four-Year Survival Data from an Ongoing Pivotal Phase 2 Study of Brentuximab Vedotin in Patients with Relapsed or Refractory Systemic Anaplastic Large Cell Lymphoma. ASH Annual Meeting 2014, Abstract 3095 [https://ash.confex.com/ash/2014/webprogram/Paper67039.html link to abstract] | ## '''Update: Abstract:''' Barbara Pro, MD, Ranjana Advani, MD, Pauline Brice, MD, Nancy L. Bartlett, MD, Joseph D. Rosenblatt, MD, Tim Illidge, Jeffrey Matous, MD, Radhakrishnan Ramchandern, MD, Michelle A. Fanale, MD, Joseph M. Connors, MD, Yinghui Wang, MS, Dirk Huebner, MD, Dana A. Kennedy, PharmD, BCOP and Andrei R. Shustov, MD. Four-Year Survival Data from an Ongoing Pivotal Phase 2 Study of Brentuximab Vedotin in Patients with Relapsed or Refractory Systemic Anaplastic Large Cell Lymphoma. ASH Annual Meeting 2014, Abstract 3095 [https://ash.confex.com/ash/2014/webprogram/Paper67039.html link to abstract] | ||
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# Gibb A, Jones C, Bloor A, Kulkarni S, Illidge T, Linton K, Radford J. Brentuximab vedotin in refractory CD30+ lymphomas: a bridge to allogeneic transplantation in approximately one quarter of patients treated on a Named Patient Programme at a single UK center. Haematologica. 2013 Apr;98(4):611-4. Epub 2012 Oct 12. [http://www.haematologica.org/content/98/4/611.long link to original article] '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3659993/ link to PMC article] [https://www.ncbi.nlm.nih.gov/pubmed/23065511 PubMed] | # Gibb A, Jones C, Bloor A, Kulkarni S, Illidge T, Linton K, Radford J. Brentuximab vedotin in refractory CD30+ lymphomas: a bridge to allogeneic transplantation in approximately one quarter of patients treated on a Named Patient Programme at a single UK center. Haematologica. 2013 Apr;98(4):611-4. Epub 2012 Oct 12. [http://www.haematologica.org/content/98/4/611.long link to original article] '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3659993/ link to PMC article] [https://www.ncbi.nlm.nih.gov/pubmed/23065511 PubMed] | ||
# '''Retrospective:''' Gopal AK, Bartlett NL, Forero-Torres A, Younes A, Chen R, Friedberg JW, Matous JV, Shustov AR, Smith SE, Zain J, O'Meara MM, Fanale MA. Brentuximab vedotin in patients aged 60 years or older with relapsed or refractory CD30-positive lymphomas: a retrospective evaluation of safety and efficacy. Leuk Lymphoma. 2014 Oct;55(10):2328-34. Epub 2014 Feb 24. [http://www.tandfonline.com/doi/full/10.3109/10428194.2013.876496 link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/24359243 PubMed] | # '''Retrospective:''' Gopal AK, Bartlett NL, Forero-Torres A, Younes A, Chen R, Friedberg JW, Matous JV, Shustov AR, Smith SE, Zain J, O'Meara MM, Fanale MA. Brentuximab vedotin in patients aged 60 years or older with relapsed or refractory CD30-positive lymphomas: a retrospective evaluation of safety and efficacy. Leuk Lymphoma. 2014 Oct;55(10):2328-34. Epub 2014 Feb 24. [http://www.tandfonline.com/doi/full/10.3109/10428194.2013.876496 link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/24359243 PubMed] | ||
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==DHAP {{#subobject:5a2988|Regimen=1}}== | ==DHAP {{#subobject:5a2988|Regimen=1}}== |
Revision as of 03:03, 12 September 2018
9 regimens on this page
12 variants on this page
|
Note: these studies were specific to ALCL or had ALCL subgroups; regimens used in PTCL, NOS are also often used in this condition.
Untreated
DA-EPOCH
back to top |
DA-EPOCH: Dose Adjusted Etoposide, Prednisone, Oncovin (Vincristine), Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin)
Regimen
Study | Evidence |
---|---|
Dunleavy et al. 2016 (NCI 93-C-0133) | Phase II |
Chemotherapy
- Etoposide (Vepesid) 50 mg/m2/day IV continuous infusion over 96 hours on days 1 to 4 (total dose per cycle: 200 mg/m2)
- Prednisone (Sterapred) 60 mg/m2 PO BID on days 1 to 5
- Vincristine (Oncovin) 0.4 mg/m2/day IV continuous infusion over 96 hours on days 1 to 4 (total dose per cycle: 1.6 mg/m2; dose was not capped)
- Cyclophosphamide (Cytoxan) 750 mg/m2 IV over 2 hours once on day 5
- Doxorubicin (Adriamycin) 10 mg/m2/day IV continuous infusion over 96 hours on days 1 to 4 (total dose per cycle: 40 mg/m2)
Supportive medications
- Filgrastim (Neupogen) 300 mcg SQ once per day, starting on day 6 and continuing until ANC greater than 5000/uL past nadir
- Trimethoprim/Sulfamethoxazole (Bactrim DS) 160/800 mg (or equivalent if allergic) PO once per day on 3 days per week
- Note: It's assumed this is what the supplement for Dunleavy et al. 2013 meant by "Baxtrim (sulphametoxazole and trimethoprim)"
- Omeprazole (Prilosec) 20 mg (or equivalent) PO once per day
- Docusate (Colace) (dose not specified) and Sennosides (Senna) 2 tablets PO BID as needed for constipation
- Lactulose 20 g PO Q6H as needed for constipation
- Hepatitis B surface antigen positive patients received daily antiviral therapy until 8 weeks after completion of chemotherapy
21-day cycle for 6 to 8 cycles
Dose adjustments
- Start cycle 1 as described above.
- Obtain CBCs twice per week for nadir measurements.
- If nadir ANC greater than 500/uL, increase etoposide, doxorubicin, and cyclophosphamide by one level (20%) compared to previous cycle.
- If nadir ANC less than 500/uL, use same doses as last cycle.
- If nadir platelet count less than 25 x 109/L, decrease etoposide, doxorubicin, and cyclophosphamide by 20% compared to the previous cycle.
References
- NCI 93-C-0133: Dunleavy K, Pittaluga S, Shovlin M, Roschewski M, Lai C, Steinberg SM, Jaffe ES, Wilson WH. Phase II trial of dose-adjusted EPOCH in untreated systemic anaplastic large cell lymphoma. Haematologica. 2016 Jan;101(1):e27-9. link to original article refers to protocol in Dunleavy et al. 2013 link to PMC article PubMed
CHOEP
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CHOEP: Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin), Oncovin (Vincristine), Etoposide, Prednisone
CHOPE
VACOP
Example orders
Regimen
Study | Evidence | Comparator | Efficacy | Toxicity |
---|---|---|---|---|
Pfreundschuh et al. 2004 (DSHNHL NHL-B1) | Phase III (E) | CHOP-21 CHOP-14 |
Not reported by subgroup | Not reported by subgroup |
This regimen was used in 20 ALCL patients (CHOEP-21) and 16 ALCL patients (CHOEP-14) in the NHL-B1 trial. The authors did not report a subgroup analysis for this minority population.
Chemotherapy
- Cyclophosphamide (Cytoxan) 750 mg/m2 IV once on day 1
- Doxorubicin (Adriamycin) 50 mg/m2 IV once on day 1
- Vincristine (Oncovin) 2 mg IV once on day 1
- Etoposide (Vepesid) 100 mg/m2 IV once per day on days 1 to 3
- Prednisone (Sterapred) 100 mg PO once per day on days 1 to 5
Supportive medications
- For 14-day cycles: Filgrastim (Neupogen) 300 mcg (for patients less than 75 kg) or 480 mcg (for patients at least 75 kg) SC once per day on days 4 to 13
- Filgrastim (Neupogen) use for 21-day cycles is by discretion of ordering physician
14 or 21-day cycles for 6 cycles, next cycle to start as long as WBC count is greater than 2.5 x 109/L and platelets greater than 80 x 109/L
- CHOEP-14 uses 14-day cycles; CHOEP-21 uses 21-day cycles
Subsequent treatment
- Patients with initial bulky disease (mass conglomerate at least 7.5 cm) received 36 Gy radiation therapy and to extranodal sites of disease when possible
References
- DSHNHL NHL-B1: Pfreundschuh M, Trümper L, Kloess M, Schmits R, Feller AC, Rudolph C, Reiser M, Hossfeld DK, Metzner B, Hasenclever D, Schmitz N, Glass B, Rübe C, Loeffler M; German High-Grade Non-Hodgkin's Lymphoma Study Group. Two-weekly or 3-weekly CHOP chemotherapy with or without etoposide for the treatment of young patients with good-prognosis (normal LDH) aggressive lymphomas: results of the NHL-B1 trial of the DSHNHL. Blood. 2004 Aug 1;104(3):626-33. Epub 2004 Feb 24. link to original article contains verified protocol PubMed
CHOP
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CHOP: Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin), Oncovin (Vincristine), Prednisone
CHOP-21
ACOP
CAVP
COPA
VACP
VCAP
Regimen
Study | Evidence | Comparator | Efficacy | Toxicity |
---|---|---|---|---|
Pfreundschuh et al. 2004 (DSHNHL NHL-B1) | Phase III, <20 pts in arm (C) | CHOEP CHOP-14 |
Not reported by subgroup | Not reported by subgroup |
This regimen was used in 14 ALCL patients in DSHNHL NHL-B1. The authors did not report a subgroup analysis for this minority population.
Chemotherapy
- Cyclophosphamide (Cytoxan) 750 mg/m2 IV once on day 1
- Doxorubicin (Adriamycin) 50 mg/m2 IV once on day 1
- Vincristine (Oncovin) 2 mg IV once on day 1
- Prednisone (Sterapred) 100 mg PO once per day on days 1 to 5
Supportive medications
- At the discretion of ordering physician: Filgrastim (Neupogen) 300 mcg (for patients less than 75 kg) or 480 mcg (for patients at least 75 kg) SC once per day on days 4 to 13
21-day cycle for 6 cycles
References
- DSHNHL NHL-B1: Pfreundschuh M, Trümper L, Kloess M, Schmits R, Feller AC, Rudolph C, Reiser M, Hossfeld DK, Metzner B, Hasenclever D, Schmitz N, Glass B, Rübe C, Loeffler M; German High-Grade Non-Hodgkin's Lymphoma Study Group. Two-weekly or 3-weekly CHOP chemotherapy with or without etoposide for the treatment of young patients with good-prognosis (normal LDH) aggressive lymphomas: results of the NHL-B1 trial of the DSHNHL. Blood. 2004 Aug 1;104(3):626-33. Epub 2004 Feb 24. link to original article contains verified protocol PubMed
Relapsed or refractory, salvage therapy
Brentuximab vedotin monotherapy
back to top |
Regimen
Study | Evidence |
---|---|
Gopal et al. 2012 (SGN35-006) | Phase II, <20 pts in subgroup |
Pro et al. 2012 (SG035-0004) | Phase II |
Gibb et al. 2012 | Named Patient Programme |
Note: SGN35-006 is a re-treatment trial; all patients were previously exposed to brentuximab vedotin. Patients who had received the 1.2 mg/kg dose on a prior trial also received that dose at re-treatment.
Chemotherapy
- Brentuximab vedotin (Adcetris) 1.8 mg/kg IV over 30 minutes on day 1
21-day cycle for up to 16 infusions (SG035-0004), as a bridge to transplant (Gibb et al. 2012), or until progression (Bartlett et al. 2014)
References
- SGN35-006: Gopal AK, Ramchandren R, O'Connor OA, Berryman RB, Advani RH, Chen R, Smith SE, Cooper M, Rothe A, Matous JV, Grove LE, Zain J. Safety and efficacy of brentuximab vedotin for Hodgkin lymphoma recurring after allogeneic stem cell transplantation. Blood. 2012 Jul 19;120(3):560-8. Epub 2012 Apr 17. link to original article contains verified protocol link to PMC article PubMed
- Update: Bartlett NL, Chen R, Fanale MA, Brice P, Gopal A, Smith SE, Advani R, Matous JV, Ramchandren R, Rosenblatt JD, Huebner D, Levine P, Grove L, Forero-Torres A. Retreatment with brentuximab vedotin in patients with CD30-positive hematologic malignancies. J Hematol Oncol. 2014 Mar 19;7:24. link to original article contains verified protocol link to PMC article PubMed
- SG035-0004: Pro B, Advani R, Brice P, Bartlett NL, Rosenblatt JD, Illidge T, Matous J, Ramchandren R, Fanale M, Connors JM, Yang Y, Sievers EL, Kennedy DA, Shustov A. Brentuximab vedotin (SGN-35) in patients with relapsed or refractory systemic anaplastic large-cell lymphoma: results of a phase II study. J Clin Oncol. 2012 Jun 20;30(18):2190-6. Epub 2012 May 21. link to original article contains verified protocol PubMed
- Update: Abstract: Barbara Pro, MD, Ranjana Advani, MD, Pauline Brice, MD, Nancy L. Bartlett, MD, Joseph D. Rosenblatt, MD, Tim Illidge, Jeffrey Matous, MD, Radhakrishnan Ramchandern, MD, Michelle A. Fanale, MD, Joseph M. Connors, MD, Yinghui Wang, MS, Dirk Huebner, MD, Dana A. Kennedy, PharmD, BCOP and Andrei R. Shustov, MD. Four-Year Survival Data from an Ongoing Pivotal Phase 2 Study of Brentuximab Vedotin in Patients with Relapsed or Refractory Systemic Anaplastic Large Cell Lymphoma. ASH Annual Meeting 2014, Abstract 3095 link to abstract
- Update: Pro B, Advani R, Brice P, Bartlett NL, Rosenblatt JD, Illidge T, Matous J, Ramchandren R, Fanale M, Connors JM, Fenton K, Huebner D, Pinelli JM, Kennedy DA, Shustov A. Five-year results of brentuximab vedotin in patients with relapsed or refractory systemic anaplastic large cell lymphoma. Blood. 2017 Dec 21;130(25):2709-2717. Epub 2017 Oct 3. link to original article PubMed
- Gibb A, Jones C, Bloor A, Kulkarni S, Illidge T, Linton K, Radford J. Brentuximab vedotin in refractory CD30+ lymphomas: a bridge to allogeneic transplantation in approximately one quarter of patients treated on a Named Patient Programme at a single UK center. Haematologica. 2013 Apr;98(4):611-4. Epub 2012 Oct 12. link to original article contains verified protocol link to PMC article PubMed
- Retrospective: Gopal AK, Bartlett NL, Forero-Torres A, Younes A, Chen R, Friedberg JW, Matous JV, Shustov AR, Smith SE, Zain J, O'Meara MM, Fanale MA. Brentuximab vedotin in patients aged 60 years or older with relapsed or refractory CD30-positive lymphomas: a retrospective evaluation of safety and efficacy. Leuk Lymphoma. 2014 Oct;55(10):2328-34. Epub 2014 Feb 24. link to original article PubMed
DHAP
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DHAP: Dexamethasone, High-dose Ara-C (cytarabine), Platinol (cisplatin)
Regimen
Study | Evidence | Comparator | Efficacy |
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Crump et al. 2014 (NCIC-CTG LY.12) | Phase III, <20 in this arm (C) | GDP | Non-inferior ORR |
Chemotherapy
- Dexamethasone (Decadron) 40 mg PO once per day on days 1 to 4
- Cytarabine (Cytosar) 2000 mg/m2 IV over 3 hours Q12H for 2 doses on day 2 (total of 2 doses)
- Cisplatin (Platinol) 100 mg/m2 IV continuous infusion over 24 hours on day 1
21-day cycle for up to 3 cycles
References
- NCIC-CTG LY.12: Crump M, Kuruvilla J, Couban S, MacDonald DA, Kukreti V, Kouroukis CT, Rubinger M, Buckstein R, Imrie KR, Federico M, Di Renzo N, Howson-Jan K, Baetz T, Kaizer L, Voralia M, Olney HJ, Turner AR, Sussman J, Hay AE, Djurfeldt MS, Meyer RM, Chen BE, Shepherd LE. Randomized comparison of gemcitabine, dexamethasone, and cisplatin versus dexamethasone, cytarabine, and cisplatin chemotherapy before autologous stem-cell transplantation for relapsed and refractory aggressive lymphomas: NCIC-CTG LY.12. J Clin Oncol. 2014 Nov 1;32(31):3490-6. Epub 2014 Sep 29. link to original article contains verified protocol PubMed
GDP
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GDP: Gemcitabine, Dexamethasone, Platinol (Cisplatin)
Regimen
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Crump et al. 2014 (NCIC-CTG LY.12) | Phase III, <20 pts in this arm (E) | DHAP | Non-inferior ORR |
Chemotherapy
- Gemcitabine (Gemzar) 1000 mg/m2 IV once per day on days 1 & 8
- Dexamethasone (Decadron) 40 mg PO once per day on days 1 to 4
- Cisplatin (Platinol) 75 mg/m2 IV once on day 1
21-day cycle for up to 3 cycles
References
- NCIC-CTG LY.12: Crump M, Kuruvilla J, Couban S, MacDonald DA, Kukreti V, Kouroukis CT, Rubinger M, Buckstein R, Imrie KR, Federico M, Di Renzo N, Howson-Jan K, Baetz T, Kaizer L, Voralia M, Olney HJ, Turner AR, Sussman J, Hay AE, Djurfeldt MS, Meyer RM, Chen BE, Shepherd LE. Randomized comparison of gemcitabine, dexamethasone, and cisplatin versus dexamethasone, cytarabine, and cisplatin chemotherapy before autologous stem-cell transplantation for relapsed and refractory aggressive lymphomas: NCIC-CTG LY.12. J Clin Oncol. 2014 Nov 1;32(31):3490-6. Epub 2014 Sep 29. link to original article contains verified protocol PubMed
Consolidation after salvage therapy
FluBuCy, then allo HSCT
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FluBuCy: Fludarabine, Busulfan, Cyclophosphamide
Regimen
Study | Evidence |
---|---|
Glass et al. 2014 (DSHNHL R3) | Phase II |
Chemotherapy
- Fludarabine (Fludara) 25 mg/m2/day IV on days -8 to -4
- Busulfan (Myleran) 4 mg/kg/day PO on days -6 to -4
- Cyclophosphamide (Cytoxan) 60 mg/kg/day IV on days -3 and -2
Immunotherapy
- Allogeneic stem cells transfused on day 0
GVHD prophylaxis
- Antithymocyte globulin, rabbit ATG (Thymoglobulin) 2 mg/kg IV from day -3 to -1 (unclear if this is a total dose or a daily dose)
- Option also to use ATG-Fresenius S at a higher dose of 10 mg/kg
- Tacrolimus (Prograf) 8 to 12 mcg/L (route/frequency not specified) starting on day -1, tapered from day +100 in absence of GVHD
- Mycophenolate mofetil (CellCept) 1000 mg (route not specified) twice per day from day +1 to +28
One course
References
- DSHNHL R3: Glass B, Hasenkamp J, Wulf G, Dreger P, Pfreundschuh M, Gramatzki M, Silling G, Wilhelm C, Zeis M, Görlitz A, Pfeiffer S, Hilgers R, Truemper L, Schmitz N; on behalf of the German High-Grade Lymphoma Study Group. Rituximab after lymphoma-directed conditioning and allogeneic stem-cell transplantation for relapsed and refractory aggressive non-Hodgkin lymphoma (DSHNHL R3): an open-label, randomised, phase 2 trial. Lancet Oncol. 2014 Jun;15(7):757-66. Epub 2014 May 11. link to original article link to original protocol (in German) contains verified protocol PubMed