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This combination regimen, often referred to as Vorinostat-R-CEP, was investigated by Memorial Sloan Kettering Cancer Center for the treatment of elderly patients with relapsed diffuse large B-cell lymphoma (DLBCL) who are ineligible for stem cell transplantation. The regimen replaces procarbazine in the standard R-CEPP protocol with vorinostat, a small molecule histone deacetylase (HDAC) inhibitor. Vorinostat works by inhibiting HDAC enzymes, leading to the accumulation of acetyl groups on histones and non-histone proteins, which alters gene expression and induces cell cycle arrest or apoptosis. The other components include rituximab (an anti-CD20 monoclonal antibody), cyclophosphamide (an alkylating agent), etoposide (a topoisomerase II inhibitor), and prednisone (a corticosteroid). This specific combination was designed to provide an effective alternative for elderly populations who may not tolerate more intensive salvage therapies.
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