open access

Vol 52, No 4 (2021)
Review article
Submitted: 2021-07-27
Accepted: 2021-07-27
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Dose adjusted R-EPOCH and other etoposide-containing regimens in first-line treatment of diffuse large B-cell lymphoma

Igor Aurer12
DOI: 10.5603/AHP.2021.0062
·
Acta Haematol Pol 2021;52(4):325-328.
Affiliations
  1. Division of Hematology, Department of Internal Medicine, University Hospital Center Zagreb, Zagreb, Croatia
  2. Medical School, University of Zagreb, Zagreb, Croatia

open access

Vol 52, No 4 (2021)
REVIEW ARTICLE
Submitted: 2021-07-27
Accepted: 2021-07-27

Abstract

Etoposide is a well-known cytotoxic agent effective in the treatment of B-large cell lymphoma (B-LCL). Currently, there is no consensus regarding the place of etoposide-containing regimens (R-CHOEP, R-ACVBP and DA-R-EPOCH) in front-line treatment of B-LCL. This paper summarizes published data and our own experience regarding the activity and toxicity of these regimens, especially DA-R-EPOCH. Most non-randomized, real-life and retrospective studies suggest that, compared to R-CHOP, DA-R-EPOCH, similarly to other etoposide-containing regimens, has superior antitumor efficacy but is also more toxic. The most important severe side-effects are hematological and infectious, making the regimen unfeasible in unfit patients. However, in fit patients with high-risk features, progression-free survival rates seem improved by 15–20% compared to R-CHOP. In our series of high-risk [age-adjusted International Prognostic Index (aaIPI) 2–3] fit [Eastern Cooperative Oncology Group (ECOG) performance status 0–2]) B-LCL patients older than 60 treated with DA-R-EPOCH, PFS at 2 years was 70%, while it was 53% in a comparable historical cohort treated with R-CHOP. DA-R-EPOCH resulted in more hematological and infectious toxicity, but no treatment-related mortality. In our opinion, DA-R-EPOCH should be considered in newly diagnosed, fit, high-risk patients with B-LCL who are older than 60, provided that there is adequate outpatient supervision, supportive care, and prompt hospital admittance in case of neutropenic fever or other severe toxicities.

Abstract

Etoposide is a well-known cytotoxic agent effective in the treatment of B-large cell lymphoma (B-LCL). Currently, there is no consensus regarding the place of etoposide-containing regimens (R-CHOEP, R-ACVBP and DA-R-EPOCH) in front-line treatment of B-LCL. This paper summarizes published data and our own experience regarding the activity and toxicity of these regimens, especially DA-R-EPOCH. Most non-randomized, real-life and retrospective studies suggest that, compared to R-CHOP, DA-R-EPOCH, similarly to other etoposide-containing regimens, has superior antitumor efficacy but is also more toxic. The most important severe side-effects are hematological and infectious, making the regimen unfeasible in unfit patients. However, in fit patients with high-risk features, progression-free survival rates seem improved by 15–20% compared to R-CHOP. In our series of high-risk [age-adjusted International Prognostic Index (aaIPI) 2–3] fit [Eastern Cooperative Oncology Group (ECOG) performance status 0–2]) B-LCL patients older than 60 treated with DA-R-EPOCH, PFS at 2 years was 70%, while it was 53% in a comparable historical cohort treated with R-CHOP. DA-R-EPOCH resulted in more hematological and infectious toxicity, but no treatment-related mortality. In our opinion, DA-R-EPOCH should be considered in newly diagnosed, fit, high-risk patients with B-LCL who are older than 60, provided that there is adequate outpatient supervision, supportive care, and prompt hospital admittance in case of neutropenic fever or other severe toxicities.

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About this article
Title

Dose adjusted R-EPOCH and other etoposide-containing regimens in first-line treatment of diffuse large B-cell lymphoma

Journal

Acta Haematologica Polonica

Issue

Vol 52, No 4 (2021)

Article type

Review article

Pages

325-328

DOI

10.5603/AHP.2021.0062

Bibliographic record

Acta Haematol Pol 2021;52(4):325-328.

Authors

Igor Aurer

References (18)
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