Dose-Adjusted R-EPOCH Therapy for Aggressive Lymphoma: A single center experience
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Abstract
Objective: When we look at diffuse large B-cell lymphomas, 5-7% are double hit lymphoma, 30-40% are double expressor lymphoma and 5-10% are triple hit lymphomas and they have an aggressive course. In our study, the efficacy of the dose-adjusted-R-EPOCH treatment regimen in the treatment of double hit lymphoma, double expressor lymphoma, triple hit lymphoma; triple expressor lymphoma and primary large B cell lymphomas of the mediastinum are presented.
Materials and Methods: Thirty-six patients diagnosed with B-cell lymphoma who received dose-adjusted R-EPOCH treatment were included in the study. The patients were grouped cytogenetically according to the Bcl-2 and Bcl-6 rearrangement by MYC translocation. Response assessment with PET-CT was performed in patients whose planned therapy reached the number of cycles.
Results: At the end of the treatment, 61% of the patients had a complete response, 3% had a partial response, and 8% had no response. During the follow-up, 9 of the patients died and while the treatment of 2 patients was still ongoing, the treatment regimen of 1 patient was changed. When the patients were evaluated, 2 had double hit lymphoma (complete response in 2 patients), 9 had double expressive lymphoma (5 patients had complete response, 2 patients had progressed disease, 1 patient died and 1 patient had a change in treatment), and 8 had triple expressor lymphoma (Complete response in 5 patients, death in 2 patients, and progressive disease in 1 patient).
Conclusion: The dose-adjusted-R-EPOCH treatment regimen can also provide a high response rate in patients with lymphoma with a triple expressor cytogenetic subtype.
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Accepted 2020-11-25
Published 2020-11-26
References
Swerdlow SH. WHO classification of tumours of haematopoietic and lymphoid tissues. WHO classification of tumours. 2008;439.
Shaoying L, Young KH and Medeiros LJ. Diffuse large B-cell lymphoma. Pathology. 2018;50:74-87.
Riedell PA, Smith SM. Double hit and double expressors in lymphoma: Definition and treatment. Cancer. 2018;124:4622-32.
Rosenthal A and Younes A. High grade B-cell lymphoma with rearrangements of MYC and BCL2 and/or BCL6: Double hit and triple hit lymphomas and double expressing lymphoma. Blood reviews. 2017;31:37-42.
Petrich AM, Gandhi M, Jovanovic B, et al. Impact of induction regimen and stem cell transplantation on outcomes in double-hit lymphoma: a multicenter retrospective analysis. Blood. 2014;124:2354-61.
Rajabto W and Dimas P. Primary CD20‐positive mediastinal diffuse large B‐cell lymphoma. Respirology Case Reports. 2020;8:668.
Camila P, Villegas P and Cabrera ME. Double or triple-expressor lymphomas: prognostic impact of immunohistochemistry in patients with diffuse large B-cell lymphoma. Hematology transfusion and cell therapy. 2020;42:192-93.
Yang XY, Zhai YP, Liu HN, et all. Long-term follow-up for 39 newly diagnosed diffused large B-cell lymphoma patients treated by (R)-EPOCH. Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2014;22:333-8.
Shah NN, Szabo A, Huntington SF, et all. R-CHOP versus dose-adjusted R-EPOCH in frontline management of primary mediastinal B-cell lymphoma: a multi-centre analysis. Br J Haematol. 2018;180:534-544.
Huang JJ, Xia Y, Wang Y, et all. A comparison of R-EPOCH and R-CHOP as a first-line regimen in de novo DLBCL patients with high Ki-67 expression in a single institution. Oncotarget. 2016;7:41242-50.
Howlett C, Snedecor SJ, Landsburg DJ, et al. Front-line, dose-escalated immunochemotherapy is associated with a significant progression-free survival advantage in patients with double-hit lymphomas: a systematic review and meta-analysis. Br J Haematol. 2015;170:504.
Sathyanarayanan V, Oki Y, Issa AK, et al. High risk diffuse large B cell lymphoma: a comparison of aggressive subtypes treated with dose adjusted chemotherapy—the University of Texas MD Anderson experience. 58th ASH Annual Meeting and Exposition, 3-6 December 2016. San Diego, USA, 106.
Aggarwal A, Rafei H, Alakeel F, et al. Outcome of patients with double-expressor lymphomas (DELs) treated with R-CHOP or R-EPOCH. 58th ASH Annual Meeting and Exposition, 3-6 December 2016. San Diego, USA, 5396.