Rituximab with dose-adjusted EPOCH as first-line treatment in patients with highly aggressive diffuse large B-cell lymphoma and autologous stem cell transplantation in selected patients

Abstract

AimTo assess the benefit of rituximab with dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (R-DA-EPOCH) regimen as a first-line treatment for patients with diffuse large B-cell lymphoma (DLBCL) presenting with unfavorable or aggressive features, and autologous stem cell transplantation (ASCT) as a part of the first-line treatment for selected DLBCL patients with additional aggressive features.MethodsWe retrospectively analyzed 75 newly diagnosed DLBCL patients with Ki-67+≥80% or International Prognostic Index ≥2 who were treated with R-DA-EPOCH between 2005 and 2015. Of 24 DLBCL patients with additional aggressive features (Ki-67+≥90% or age-adjusted IPI≥2) who were planned to receive consolidation with ASCT, 17 patients underwent the procedure. We determined the overall response rate (ORR), complete remission (CR), partial remission (PR), 5-year overall survival (OS), and progression free survival (PFS) in all DLBCL patients and specifically those planned to receive ASCT.ResultsAll 75 patients included in the analysis started one or more cycles of therapy. The ORR, CR, and PR rates were 80%, 55%, and 25%, respectively. The response was non-evaluable in 10 of 75 patients due to treatment discontinuation. The OS and PFS rates for all 75 patients were 70% and 61%, respectively, and 80% and 79%, respectively, for 24 planned-to-receive-ASCT patients. Age (≤65 vs >65 years) had no prognostic impact on OS and PFS (P = 0.994 and P = 0.827, respectively).ConclusionOur retrospective analysis of one of the largest DLBCL patient cohorts outside the US National Cancer Institute showed that R-DA-EPOCH is a very effective therapeutic option as a first-line treatment of DLBCL patients with unfavorable prognostic features irrespective of their age. ASCT provided additional benefit for DLBCL patients with additional aggressive features.

<p>Efficacy of dose-adjusted EPOCH plus rituximab/R-CHOP regimens and the prognosis analysis in patients with <em>MYC</em>, <em>BCL2/BCL6</em> gene copy number gain lymphoma and double-hit lymphoma: results from a single institution retrospective clinical study</p>

“…At present, there is no international consensus on the standardized treatment for DHL/double CNG. Some investigators have analyzed prognosis by increasing the dose or density of chemotherapy and observed better therapeutic effects 15–23,26. In recent years, two large-scale retrospective clinical analyses17,36 have shown that the application of R-DA-EPOCH regimen significantly increased the PFS compared with other regimens in DHL.…”

“…It is also worth noting that the highly invasive nature of these disease types confers a higher recurrence rate. Whether consolidation therapy, such as hematopoietic stem cell transplantation, is needed after complete remission (CR) remains controversial 24–26. We aimed to compare the efficacy and adverse effects of R-DA-EPOCH with R-CHOP in patients with DHL and double CNG.…”

Double-hit monomorphic B-cell lymphoma after liver transplantation

“…A study has shown that there was no significant difference in the overall survival of patients treated with either the standard or more aggressive regimen 14. However, other studies have shown that DA-EPOCH-R is an effective first-line regimen in diffuselarge B-cell lymphoma associated with unfavourable prognosis irrespective of patient’s age 17 18. Neutropenia and secondary sepsis are common toxicities of this chemotherapeutic regimen that can be prevented by prophylactic filgrastim and antibiotics.…”

Primary Gastrointestinal Diffuse Large B-cell Lymphoma

“…Chemotherapy is preferred by many physicians, particularly when treating patients with a high-grade tumor such as DLBCL [ 4 ]. With the advent of rituximab (a chimeric monoclonal antibody against the protein CD20), use of DaRR-EPOCH as the first-line therapy in high-grade B-cell lymphoma can be beneficial [ 19 ]. However, rituximab use has raised concerns about a higher incidence of neutropenic infections.…”