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

Scientific paper - Original scientific paper

• Author: Vlatko Pejša
• Author: Željko Prka
• Author: Marko Lucijanić
• Author: Zdravko Mitrović
• Author: Mario Piršić
• Author: Ozren Jakšić
• Author: Radmila Ajduković
• Author: Rajko Kušec
• Author's institution: University of Zagreb; School of Medicine
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences

Abstract (english)

AIM:
To 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. -----

METHODS:

We 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. -----

RESULTS:

All 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). -----

CONCLUSION:

Our 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.

• Keywords (english): Adult; Aged; Antibodies, Monoclonal, Murine-Derived; Antineoplastic Combined Chemotherapy Protocols/administration & dosage; Antineoplastic Combined Chemotherapy Protocols/therapeutic use; Cyclophosphamide/administration & dosage; Cyclophosphamide/therapeutic use; Disease-Free Survival; Doxorubicin/administration & dosage; Doxorubicin/therapeutic use; Etoposide/administration & dosage; Etoposide/therapeutic use; Female; Hematopoietic Stem Cell Transplantation/methods; Humans; Lymphoma, Large B-Cell, Diffuse/drug therapy; Lymphoma, Large B-Cell, Diffuse/mortality; Lymphoma, Large B-Cell, Diffuse/therapy; Male; Middle Aged; Prednisone/administration & dosage; Prednisone/therapeutic use; Prognosis; Retrospective Studies; Rituximab/administration & dosage; Rituximab/therapeutic use; Treatment Outcome; Vincristine/administration & dosage; Vincristine/therapeutic use
• Language: english
• Publication type: Scientific paper - Original scientific paper
• Publication status: Published
• Peer review: Peer review
• Publication version: Published version
• Journal title: Croatian Medical Journal
• Numbering: vol. 58, no. 1, pp. 40-48
• p-ISSN: 0353-9504
• DOI: https://doi.org/10.3325/cmj.2017.58.40
• URN:NBN: urn:nbn:hr:105:668434
• Publication: 2017-02-28
• Document URL: https://doi.org/10.3325/cmj.2017.58.40
• Type of resource: Text
• Access conditions: Open access
• Created on: 2024-03-28 09:10:47