DA-EPOCH-R improves the outcome over that of R-CHOP regimen for DLBCL patients below 60 years, GCB phenotype, and those with high-risk IPI, but not for double expressor lymphoma.

Abstract

PURPOSE:

This study was to compare DA-EPOCH-R and R-CHOP regimen as first-line therapy in diffuse large B cell lymphoma (DLBCL) patients, retrospectively.

METHODS:

A total of 252 cases treated with R-CHOP and 146 cases who received DA-EPOCH-R were enrolled into this study.

RESULTS:

Overall, 162 (64.3%) and 105 patients (71.9%) achieved complete remission, 43 (17.1%) and 14 patients (9.6%) achieved partial remission following R-CHOP and DA-EPOCH-R regimen, respectively. After a median follow-up of 48 months, better progression-free survival (PFS) was seen in DA-EPOCH-R group, but no better overall survival (OS) was found in patients treated with DA-EPOCH-R compared to R-CHOP (P = 0.015 for PFS, P = 0.19 for OS). However, subgroup analysis according to cell of origin, international prognostic index (IPI), and age showed DA-EPOCH-R resulted in significantly better PFS and OS than R-CHOP regimen in patients with germinal center B-cell-like (GCB) phenotype (P = 0.002 for PFS, P = 0.007 for OS), high IPI (P = 0.002 for PFS; P = 0.03 for OS), and with a younger age (P = 0.002 for PFS, P = 0.045 for OS). We also compared two regimens in patients with double expressor lymphoma (DEL). The prognosis of DEL patients was significantly worse than non-DEL patients (P < 0.001 for PFS, P < 0.001 for OS), but DA-EPOCH-R regimen may not overcome the poor prognosis (P = 0.47 for PFS, P = 0.79 for OS).

CONCLUSION:

GCB DLBCL, younger patients, and high-risk patients, but not DEL patients, may benefit from continuous-infusion DA-EPOCH-R regimen.

• Authors: Xin-Yu Zhang, Jin-Hua Liang, Li Wang, Hua-Yuan Zhu, Wei Wu, Lei Cao, Lei Fan, Jian-Yong Li, Wei Xu
• Journal: Journal of cancer research and clinical oncology (J Cancer Res Clin Oncol) Vol. 145 Issue 1 Pg. 117-127 (Jan 2019) ISSN: 1432-1335 [Electronic] Germany
• PMID: 30327941 (Publication Type: Journal Article)

Chemical References

• Antibodies, Monoclonal, Murine-Derived
• Proto-Oncogene Proteins c-bcl-2
• Proto-Oncogene Proteins c-myc
• R-CHOP protocol
• Rituximab
• Vincristine
• Etoposide
• Doxorubicin
• Cyclophosphamide
• Prednisone

Topics

• Adolescent
• Adult
• Age Factors
• Aged
• Aged, 80 and over
• Antibodies, Monoclonal, Murine-Derived (administration & dosage, adverse effects)
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage, adverse effects)
• Cyclophosphamide (administration & dosage, adverse effects)
• Disease-Free Survival
• Doxorubicin (administration & dosage, adverse effects)
• Etoposide (administration & dosage, adverse effects)
• Female
• Humans
• Infusions, Intravenous
• Lymphoma, Large B-Cell, Diffuse (drug therapy, metabolism)
• Male
• Middle Aged
• Phenotype
• Prednisone (administration & dosage, adverse effects)
• Prognosis
• Proto-Oncogene Proteins c-bcl-2 (metabolism)
• Proto-Oncogene Proteins c-myc (metabolism)
• Remission Induction
• Retrospective Studies
• Rituximab
• Treatment Outcome
• Vincristine (administration & dosage, adverse effects)