title: Long-term follow-up of dose-adjusted EPOCH plus rituximab (DA-EPOCH-R) in untreated patients with poor prognosis large B-cell lymphoma. A phase II study conducted by the Spanish PETHEMA Group.
abstract: This prospective multi-institutional phase II study was designed to assess the efficacy and safety of dose-adjusted EPOCH (etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin) plus rituximab (DA-EPOCH-R) in untreated patients with poor prognosis large B-cell lymphomas. Eighty-one patients diagnosed with diffuse large B-cell lymphoma (DLBCL, n = 68), primary mediastinal DLBCL (n = 6) and follicular lymphoma Grade 3b (n = 7), with an age-adjusted International Prognostic Index >1, were eligible for analysis. Median age was 60 years (range: 21-77). Sixty-five patients (80·2%) achieved complete response. After a median follow-up time of 64 months, 10-year event-free survival and overall survival (OS) were 47·8% and 63·6%, respectively. None of the studied clinical and biological characteristics were associated with poorer outcome. Interestingly, patients with BCL6 rearrangement achieved a 10-year OS of 100%, while patients with BCL2 rearrangement exhibited a poorer outcome compared to activated B-cell tumours and germinal centre B-cell without BCL2 rearranged tumours. Results achieved with DA-EPOCH-R showed a good long-term outcome and a tolerable toxicity profile in high-risk large B cell lymphoma patients. Outcome was not affected by tumour cell proliferation or by cell of origin, highlighting the requirement of new biological markers for patient subclassification of high-risk DLBCL patients.
authors.affiliation: Department of Haematology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
authors.forename: Noelia
authors.initials: N
authors.lastname: Purroy
authors.forename: Juan
authors.initials: J
authors.lastname: Bergua
authors.forename: Laura
authors.initials: L
authors.lastname: Gallur
authors.forename: Julio
authors.initials: J
authors.lastname: Prieto
authors.forename: Luis A
authors.initials: LA
authors.lastname: Lopez
authors.forename: Juan M
authors.initials: JM
authors.lastname: Sancho
authors.forename: Jose A
authors.initials: JA
authors.lastname: García-Marco
authors.forename: Josep
authors.initials: J
authors.lastname: Castellví
authors.forename: Santiago
authors.initials: S
authors.lastname: Montes-Moreno
authors.forename: Ana
authors.initials: A
authors.lastname: Batlle
authors.forename: Sonia Gonzalez
authors.initials: SG
authors.lastname: de Villambrosia
authors.forename: Fernando
authors.initials: F
authors.lastname: Carnicero
authors.forename: Lucía
authors.initials: L
authors.lastname: Ferrando-Lamana
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Piris
authors.forename: Andrés
authors.initials: A
authors.lastname: Lopez
mesh_terms: D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use; D004317:Doxorubicin / Q000009:adverse effects / Q000627:therapeutic use; D005047:Etoposide / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use; D011379:Prognosis; D000069283:Rituximab; D016896:Treatment Outcome; D014750:Vincristine / Q000009:adverse effects / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D014750:Vincristine; D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
keywords: and rituximab); cell of origin; cyclophosphamide; dose-adjusted-EPOCH-R (etoposide, prednisone; doxorubicin; high-risk patients; large B-cell lymphoma; vincristine