Intensified regimens improve event-free survival (EFS) and overall survival (OS) in patients newly diagnosed with diffuse large B-cell lymphoma (DLBCL) compared with standard therapy, according to research presented at the 22nd Congress of the European Hematology Association (June 22-25, 2017; Madrid, Spain).
Rituximab, cyclophosphamide, hydroxydaunomycin, oncovin, and prednisone (R-CHOP) often serves as standard therapy for patients with DLBCL. However, patients with high-risk disease tend to have unsatisfactory outcomes. Recent studies have suggested that intensified regimens such as R-CHOEP14 and DA-R-EPOCH—both with the inclusion of etoposide—improve treatment results in patients with DLBCL.
Sandra Basic-Kinda, department of internal medicine, University Hospital Centre Zagreb (Croatia), and colleagues conducted a study to compare treatment outcomes of patients with DLBCL treated with standard therapy (R-CHOP21) with those who were treated with more intensive regimens (R-CHOEP14 or DA-R-EPOCH). Additionally, EFS and OS outcomes were grouped together for further analysis. Patient data was obtained from the KroHem registry, the Croatian Cooperative Group for Hematologic Diseases.
A total of 54 patients received R-CHOP21, while 40 received R-CHOEP14 and 22 received DA-R-EPOCH. Patients were aged 60 years or younger and demonstrated similar disease characteristics. Each treatment regimen was administered for 6-8 cycles in accordance with standard guidelines. Additionally, patients in partial remission or with initial bulky disease were irradiated after the end of systemic treatment.
Results of the study indicated that response rates among patients receiving standard therapy and those receiving more intensive regimens were similar. However, EFS and OS in patients receiving R-CHOP were inferior to those receiving more intensive regimens (5-year EFS rate, 58% vs 78%; 5-year OS rate, 60% vs 80%; respectively).
A multivariate Cox regression model adjusted for age, gender and presence of bulky disease showed that differences in outcomes between R-CHOP and intensified regimens remained significant.
“Our data suggests that the addition of etoposide to R-CHOP and increase in dose-intensity improve EFS and OS of younger patients with newly diagnosed high-risk [DLBCL],” the researchers concluded. “R-CHOEP14 and DA-R-EPOCH seem to be similarly effective in this setting.”—Christina Vogt
