ABCL-064: "DA-EPOCH+/-R" protocol in high-grade lymphoma: An analysis

Abstract

Context: DA-EPOCH (dose-adjusted etoposide, doxorubicin, cyclophosphamide, vincristine, and prednisolone) ± R (rituximab) is one of the standard chemotherapeutic regimens for high-grade lymphomas. Objective: This study aimed to evaluate the safety and efficacy of DA-EPOCH±R in an Indian context. Design and Setting: This retrospective study included 47 patients with high-grade lymphoma who received uniform DA-EPOCH±R protocol with GCSF prophylaxis in the Department of Medical Oncology at All India Institute of Medical Sciences, New Delhi, India, from May 1, 2013 to April 30, 2021. Results: The median age was 35 years (16–69). The primary diagnosis of 47 cases was as follows: primary mediastinal B cell lymphoma (n=16), Burkitt's lymphoma (n=16), plasmablastic lymphoma (n=6), double-hit diffuse large B cell lymphoma (n=4), angioimmunoblastic lymphoma (n=2), peripheral T cell lymphoma NOS (n=1), and lymphomatoid granulomatosis (n=2). The stage distribution was: stage I, 5 (10.6%); stage II, 14 (29.8%); stage III, 11 (23.4%), and stage IV, 17 (36.17%). Bulky disease was seen in 24 (51.06%) cases, and bone marrow was involved in 9 (19.1%) cases. Extranodal involvement and bulky disease were present in 23 (48.9%) and 28 (59.5%) cases, respectively. Poor performance status (ECOG>2) and high-risk IPI were present in 46% and 60%, respectively. Five cases were HIV-positive. Rituximab was used in 30 cases of CD20+ B cell lymphoma. After the median 5 cycles (range 2–6) of chemotherapy, the overall response was 91%, and 78% of patients achieved complete remission. The maximum dose intensity was level 3 in 34%, level 2 in 55%, and level 1 in the remaining cases. There were no treatment-related deaths. The most common hematological toxicities (grade 3–4) were neutropenia in 8 patients, thrombocytopenia in 3, and anemia in 2 patients. Febrile neutropenia was observed in 5 patients. Infections, thrombosis, Grade 3 peripheral neuropathy, and ileus were documented in 11, 4, 2 and 1 case, respectively. In our study, 2-year event-free survival and overall survival were 70% and 80%, respectively, with a median follow-up period of 30 months. Conclusion: DA-EPOCH ±R is feasible and efficacious in real-world clinical practice for aggressive lymphoma of both B-cell and T-cell immunophenotypes.