Key clinical point: A treatment strategy was designed for hemodialysis-dependent patients with end-stage renal disease who have relapsed/refractory DLBCL.

Major finding: A salvage chemotherapy of dose-adjusted R-GDC or CHASER regimen followed by ASCT using a conditioning regimen of reduced melphalan and pharmacokinetically targeted busulfan had acceptable adverse events.

Study details: A single patient was treated using the designed regimen.

Disclosures: The authors declared that they had no conflicts of interest.

Commentary

“Literature regarding management of lymphoma patients on hemodialysis (HD) is scant. Standard second line treatment for diffuse large B-cell lymphoma (DLBCL) is high dose chemotherapy followed by autologous stem cell transplant (ASCT). Drs Morita et al report on dose adjusted chemotherapy regimen CHASER (modified rituximab, cyclophosphamide, cytosine arabinoside, etoposide, and dexamethasone) in a refractory DLBCL patient with end stage renal disease (ESRD) who was dialyzed daily while on this treatment. He had a partial response, followed by mobilization of stem cells, conditioning with reduced dose melphalan/busulfan and then ASCT. He then had a complete response but unfortunately died shortly after ASCT due to disease progression. This report demonstrates feasibility of aggressive treatment strategy in patients with ESRD.”

Sarah Rutherford, MD

Assistant Professor of Medicine, Weill Cornell Medicine