Contributions
Abstract: PB1750
Type: Publication Only
Background
CHOP is the standard chemotherapeutic regimen for aggressive lymphomas. CHOP with rituximab (R) therapy is the standard of care for newly diagnosed diffuse large B-cell lymphoma (DLBCL), but it is not sufficient for DLBCL with adverse prognostic factors. Excellent efficacy of dose-adjusted (DA)-EPOCH -/+ R therapy has been reported for primary mediastinal large B-cell lymphoma (med DL), Burkitt lymphoma, and peripheral T-cell lymphomas (PTCLs). A phase II study on DA-EPOCH-R/high-dose methotrexate therapy for untreated stage II-IV CD5+ DLBCL also demonstrated promising efficacy (Miyazaki et al. ASH2016). However, the feasibility and efficacy of DA-EPOCH -/+ R in clinical practice has not been fully evaluated.
Aims
To evaluate the feasibility and efficacy of DA-EPOCH -/+ R for aggressive lymphomas in clinical practice, we conducted a retrospective study.
Methods
We retrospectively analyzed clinical features and outcomes of 149 patients with aggressive lymphoma who received DA-EPOCH -/+ R between 2007 and 2015 in 17 institutes in Japan.
Results
The patients’ characteristics were as follows: male, 55%; median age, 62 years (range, 17-87); > 65 y.o, 44%; no prior treatment, 60%; DLBCL, 54%; ECOG PS > 1, 35%; and stage III/IV, 78%. All patients were hospitalized, and a central venous catheter was used in 96% of patients. The maximum dose level of DA-EPOCH was < 1 in 13% of patients, level 1 in 57%, level 2 in 11%, level 3 in 13%, and > 3 in 7%. The median number of cycles was 4 (range, 1-8). There was no treatment-related death. Grade 3/4 febrile neutropenia, infection, and constipation were documented in 54%, 28%, and 6% of patients, respectively. In elderly patients (≥ 65 y.o), these were 60%, 32%, and 9%, respectively. Only constipation (all grades) and neutropenia (grade 3/4) occurred more frequently in elderly patients than in younger patients. Patients with newly diagnosed DLBCL-NOS (n = 46) exhibited the following clinical features: median age: 65 years (range, 28-87); > 65 y.o, 50%; male, 50%; ECOG PS > 1, 46%; and stage III/IV, 83%; IPI high/high intermediate, 73%; CD5+, 49%. The median follow-up duration was 23.9 months (range, 2.2-79.9). CR and estimated 2-year OS rates were 80% and 81%, respectively. There was no difference in OS according to dose levels of DA-EPOCH-R. The estimated 2-year OS rate for med DL (n = 14) was 100%.
Conclusion
These results suggest that DA-EPOCH -/+ R is feasible in clinical practice and safe for elderly patients. Promising efficacy of DA-EPOCH -/+ R for aggressive lymphomas was also observed in this study, warranting further evaluation.
Session topic: 21. Aggressive Non-Hodgkin lymphoma - Clinical
Keyword(s): Clinical outcome, Malignant lymphoma, Treatment
Abstract: PB1750
Type: Publication Only
Background
CHOP is the standard chemotherapeutic regimen for aggressive lymphomas. CHOP with rituximab (R) therapy is the standard of care for newly diagnosed diffuse large B-cell lymphoma (DLBCL), but it is not sufficient for DLBCL with adverse prognostic factors. Excellent efficacy of dose-adjusted (DA)-EPOCH -/+ R therapy has been reported for primary mediastinal large B-cell lymphoma (med DL), Burkitt lymphoma, and peripheral T-cell lymphomas (PTCLs). A phase II study on DA-EPOCH-R/high-dose methotrexate therapy for untreated stage II-IV CD5+ DLBCL also demonstrated promising efficacy (Miyazaki et al. ASH2016). However, the feasibility and efficacy of DA-EPOCH -/+ R in clinical practice has not been fully evaluated.
Aims
To evaluate the feasibility and efficacy of DA-EPOCH -/+ R for aggressive lymphomas in clinical practice, we conducted a retrospective study.
Methods
We retrospectively analyzed clinical features and outcomes of 149 patients with aggressive lymphoma who received DA-EPOCH -/+ R between 2007 and 2015 in 17 institutes in Japan.
Results
The patients’ characteristics were as follows: male, 55%; median age, 62 years (range, 17-87); > 65 y.o, 44%; no prior treatment, 60%; DLBCL, 54%; ECOG PS > 1, 35%; and stage III/IV, 78%. All patients were hospitalized, and a central venous catheter was used in 96% of patients. The maximum dose level of DA-EPOCH was < 1 in 13% of patients, level 1 in 57%, level 2 in 11%, level 3 in 13%, and > 3 in 7%. The median number of cycles was 4 (range, 1-8). There was no treatment-related death. Grade 3/4 febrile neutropenia, infection, and constipation were documented in 54%, 28%, and 6% of patients, respectively. In elderly patients (≥ 65 y.o), these were 60%, 32%, and 9%, respectively. Only constipation (all grades) and neutropenia (grade 3/4) occurred more frequently in elderly patients than in younger patients. Patients with newly diagnosed DLBCL-NOS (n = 46) exhibited the following clinical features: median age: 65 years (range, 28-87); > 65 y.o, 50%; male, 50%; ECOG PS > 1, 46%; and stage III/IV, 83%; IPI high/high intermediate, 73%; CD5+, 49%. The median follow-up duration was 23.9 months (range, 2.2-79.9). CR and estimated 2-year OS rates were 80% and 81%, respectively. There was no difference in OS according to dose levels of DA-EPOCH-R. The estimated 2-year OS rate for med DL (n = 14) was 100%.
Conclusion
These results suggest that DA-EPOCH -/+ R is feasible in clinical practice and safe for elderly patients. Promising efficacy of DA-EPOCH -/+ R for aggressive lymphomas was also observed in this study, warranting further evaluation.
Session topic: 21. Aggressive Non-Hodgkin lymphoma - Clinical
Keyword(s): Clinical outcome, Malignant lymphoma, Treatment