A more aggressive alternative to standard chemotherapy schemes could be beneficial for selected patients with diffuse large B-cell lymphoma (DLBCL), according to a study recently published in the European Journal of Haematology.
“Patients with good/intermediate [performance status] able to tolerate dose escalation have the greatest benefit,” the authors wrote.
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This prospective, multicenter, observational study included 120 patients previously diagnosed with DLBCL aged 60 years and over, with a median age of 69 years. Sex distribution was almost equal, with male patients comprising 52% of the cohort.
The participants together received 592 cycles of dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (DA-EPOCH-R), with a median number of cycles of 6 per patient and a median duration of 24.7 days.
The response rate was 74%, and 59% of the patients achieved a complete response. Importantly, the overall survival rate was 58%, and the 3-year progression-free survival rate was 53%. On the other hand, treatment-related mortality was 13%.
Almost half (42%) of the individuals underwent dose escalation, and 22% needed a dose reduction. Some patients also received treatment with radiotherapy (n=24), prophylactic intrathecal (n=18) or intravenous methotrexate (n=15), or autologous stem cell transplant (n=6).
A considerable proportion (39%) abandoned DA-EPOCH-R treatment before cycle number 6. The most common reason was death in 23 patients, followed by treatment-related adverse effects in 9 patients, end of treatment due to remission in 7 patients, physician decision in 5 patients, and other reasons in 3 patients.
In addition, among those participants that discontinued DA-EPOCH-R, 10 received rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) and 5 received other chemotherapeutic variants.
Although the risk of drug toxicity is higher with DA-EPOCH-R than standard schemes, this study demonstrated favorable results in selected patients. For example, a performance status between 0 and 2 and an age of less than 70 years constituted favorable prognostic factors.
“In conclusion, our results show that DA-EPOCH-R is an efficacious, yet toxic protocol in older high-risk patients with DLBCL,” the authors concluded.
Reference
Mitrovic Z, Dujmovic D, Jaksic O, et al. Dose-adjusted EPOCH and rituximab (DA-EPOCH-R) in older patients with high-risk aggressive diffuse large B-cell lymphoma: a real-life multicenter study by the Croatian Cooperative Group for Hematologic Diseases (KroHem). Eur J Haematol. Published online March 20, 2023. doi:10.1111/ejh.13957
