A recently published study in Cancer Medicine revealed that decitabine combined with rituximab, dexamethasone, cytarabine, and cisplatin (RDHAP), has been an effective, well-tolerated and could be a promising treatment option for patients with relapsed/refractory diffuse large B-cell lymphoma (R/R-DLBCL).

Diffuse large B-cell lymphoma (DLBCL), the most common subtype of non-Hodgkin lymphoma (NHL), accounts for about 30%–40% of cases, the study team noted.

Read more about diffuse large B-cell lymphoma therapies

Rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine, and prednisone (R-CHOP) regimen is the current standard treatment option; however, many patients relapse or develop refractory diseases. Only 13% of such patients undergo high-dose chemotherapy followed by autologous stem cell transplantation (HDT-ASCT), the authors added.

Decitabine, a phase-S DNA methylation inhibitor in hematological and solid tumor malignancies, has reported promising outcomes. DNA demethylation and hematopoietic stem cell differentiation have been induced through low-dose decitabine. Furthermore, decitabine can restore chemotherapy sensitivity to anthracyclines by reactivating SMAD1 expression.

The study evaluated the safety and efficacy of decitabine in combination with RDHAP in patients with R/R-DLBCL. The research team recruited 56 patients between 2018 and 2021. There were 35 patients in the decitabine-RDHAP group and 21 in the RDHAP group.

To be eligible for this study, patients had to be between 14 and 70 years of age, had a confirmed diagnosis of DLBCL, had received previous treatment with CHOP or RCHOP, had an estimated survival time of more than 3 months, and had no contraindications. Patients with relapsed DLBCL must have achieved a complete response to initial chemotherapy, but then experienced a relapse after 6 months.

Study results indicated that 10 patients in the decitabine-RDHAP group and 4 patients in the RDHAP group achieved complete response. Moreover, the objective response rate was reported to be 40% in the decitabine-RDHAP group and 33% in the RDHAP group, with no considerable difference in the response rate between the 2 groups. Additionally, no significant differences in overall survival (OS), progression-free survival (PFS), or duration of disease control were found between the 2 groups.

However, a significant difference in the duration of response (DOR) was observed. Furthermore, for patients with only 1 previous line of therapy, the median PFS in the decitabine-RDHAP and RDHAP groups were 7 and 4 months, respectively.

In contrast, the median OS was 17.0 and 13.5 months, respectively, and these differences were significant (P= .026 and P= .0093, respectively). Moreover, the 2 groups observed no significant differences in the liver, digestive tract, kidney, heart, or neurotoxicity.

The authors noted several limitations in the study, including the need for clinical studies on using decitabine to treat DLBCL in China. Furthermore, a significant number of patients received additional treatment strategies after taking part in the study. Additionally, the research was likely constrained by a relatively small sample size. To investigate the efficacy of combining decitabine with the RDHAP regimen for DLBCL treatment, more sophisticated randomized controlled trials should be conducted.

We consider that the decitabine-RDHAP regimen is a promising treatment option for the early treatment of DLBCL,” the authors concluded.


Kong X, Zhang X, Zhang M, et al. Decitabine combined with RDHAP regimen in relapsed/refractory diffuse large B cell lymphoma. Cancer Med. Published online January 25, 2023. doi: 10.1002/cam4.5615