Journal of Blood Disorders & Transfusion

Outcomes of newly diagnosed diffuse large B cell lymphoma treated with rituximab dose-adjusted EPOCH and rituximab-CHOP at King Chulalongkorn Memorial Hospital

7^th World Hematologists Congress

May 08-09, 2017 Barcelona, Spain

Tanintorn Sinsomboonthong and Kitsada Wudhikarn

Chulalongkorn University, Thailand

Posters & Accepted Abstracts: J Blood Disord Transfus

Abstract:

Background: Since the introduction of rituximab (R), outcome of diffuse large B cell lymphoma (DLBCL) has significantly improved. R-CHOP (C: Cyclophosphamide, H: Adriamycin, O: Vincristine and P: Prednisolone) has been the standard treatment over the past decade. However, about 30% of DLBCL relapsed or were refractory to the treatment. There were evidence showing benefit of adding etoposide (E) and administrating treatment in a dynamic dose adjusting fashion so called dose-adjusted (DA) EPOCH. Several phase II trials showed promising outcome of R-DA-EPOCH especially in some DLBCL subtypes such as primary mediastinal B cell lymphoma. We hypothesized that R-DA-EPOCH would be better than R-CHOP in DLBCL not otherwise specified (NOS). Herein, we compared treatment outcome of DLBCL patients treated with R-CHOP and R-DAEPOCH at our institution. Samples & Methods: We identified 178 newly diagnosed DLBCL-NOS patients treated with at least one cycle of R-CHOP or R-DA-EPOCH at the King Chulalongkorn Memorial Hospital between January 2011 and August 2016 (150 R-CHOP and 28 R-DA-EPOCH). We described baseline characteristics, treatment and compared toxicities including outcomes between R-CHOP and R-DA-EPOCH treated DLBCL patients. Results: Baseline characteristics are summarized in table 1. R-DA-EPOCH treated patients were significantly older, had higher proportion of B symptoms, elevated LDH and high intermediate/high risk diseases. The overall response rate was similar between two groups (97.3% in R- CHOP vs. 92.9% in R-DA-EPOCH). At the time of analysis, 20 patients had died (15 R-CHOP and R-DA-EPOCH). With a median follow up duration of 32 months, 2-year progression free survival (PFS), overall survival (OS) for the entire cohort was 89% and 92.1% respectively. R-CHOP treated patients had similar PFS but marginally better OS than R-DA-EPOCH cohorts (90.2% vs. 80.9%, P=0.09 for PFS and 93.1% vs. 85.3%, P=0.05 for OS) (Figure 1). Subgroup analysis on 77 high-risk patients, PFS and OS were not different between R-CHOP and R-DA-EPOCH treated patients (Figure 2). R-DA-EPOCH had more grade III/IV hematological toxicities. Univariable analysis identified elevated LDH, advanced stage disease and HI/high IPI as significant risk factor of inferior survival. Cell of origin was not a predictive factor in our cohort but germinal center B cell (GCB) like DLBCL who received R-DA-EPOCH showed trend toward better survival. Using multiple variable cox proportional hazard analysis, HI/high IPI is the only independent factor of inferior survival. Conclusions: In our study, DLBCL treated with R-DA-EPOCH had similar outcome to R-CHOP treated cohort. Whether R-DA-EPOCH would be more beneficial for specific subset, this finding may be re-evaluated in larger prospective controlled trial. Further analysis of CALGB 50303 is pending and would be informative.

Biography :

Email: pang30449@gmail.com