title: Dose-Adjusted Etoposide, Prednisone, Vincristine, Cyclophosphamide, and Doxorubicin (EPOCH) With or Without Rituximab as First-Line Therapy for Aggressive Non-Hodgkin Lymphoma.
abstract: BACKGROUND
  Dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (DA-EPOCH) was developed in an effort to overcome inadequate drug concentrations and compensate for increased drug clearance. The goal of the present study was to examine the risk factors and outcomes of patients with aggressive non-Hodgkin lymphoma (aNHL) treated with DA-EPOCH.
  
  
  METHODS
  We report the data from 136 patients with previously untreated aNHL who received infusional DA-EPOCH chemotherapy with or without rituximab from 2005 to 2013. Overall survival was estimated using Kaplan-Meier methods. Univariate and multivariate logistic regression was used to determine the factors associated with death, progression, or relapse at 2 years.
  
  
  RESULTS
  The overall response rate was 82%. The relapse-free survival rate at 1, 3, and 5 years was 68%, 63%, and 52% with 95% confidence intervals (CIs) of 0.59% to 0.85%, 0.54% to 0.70%, and 0.31% to 0.70%, respectively. Patients with T-cell aNHL had an increased risk of death, progression, or relapse (Odds Ratio, 3.5; 95% CI, 1.4-8.8) compared with those with B-cell aNHL. In multivariate analysis, current smoking, disease in the bone marrow, and the number of cycles completed were independent predictors of death and relapse.
  
  
  CONCLUSIONS
  Our data suggest that EPOCH with or without rituximab is active in both B- and T-cell aNHL. Toxicity did not significantly affect timing of treatment delivery or treatment outcomes. Dose adjustment by hematopoietic nadir similarly had no effect. The effect of smoking during chemotherapy should be evaluated further.
authors.affiliation: Section of Hematology and Oncology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC; Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC. Electronic address: zlamar@wakehealth.edu.
authors.forename: Zanetta S
authors.initials: ZS
authors.lastname: Lamar
authors.affiliation: Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Nora
authors.initials: N
authors.lastname: Fino
authors.affiliation: Section of Hematology and Oncology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Jodi
authors.initials: J
authors.lastname: Palmer
authors.affiliation: Department of Pharmacy, Wake Forest Baptist Medical Center, Winston-Salem, NC.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Gruber
authors.affiliation: Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC.
authors.forename: Bonny B
authors.initials: BB
authors.lastname: Morris
authors.affiliation: Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Olga
authors.initials: O
authors.lastname: Raetskaya-Solntseva
authors.affiliation: Department of Pharmacy, Wake Forest Baptist Medical Center, Winston-Salem, NC.
authors.forename: LeAnne
authors.initials: L
authors.lastname: Kennedy
authors.affiliation: Section of Hematology and Oncology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC; Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC.
authors.forename: Rakhee
authors.initials: R
authors.lastname: Vaidya
authors.affiliation: Section of Hematology and Oncology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC; Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC.
authors.forename: David
authors.initials: D
authors.lastname: Hurd
authors.affiliation: Section of Hematology and Oncology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Zamkoff
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001402:B-Lymphocytes / Q000187:drug effects; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy*; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy; D011241:Prednisone / Q000008:administration & dosage; D011379:Prognosis; D000069283:Rituximab / Q000008:administration & dosage*; D015996:Survival Rate; D013601:T-Lymphocytes / Q000187:drug effects; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D000069283:Rituximab; D014750:Vincristine; D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
keywords: Antineoplastic combined chemotherapy protocols; Dose-adjusted EPOCH protocol; Multivariate analysis; Patient outcomes; Smoking