Abstract
Diffuse large B-cell lymphoma (DLBCL) patients with high Ki-67 expression receive limited benefits from R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) therapy. This study aims to compare the R-EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin) and R-CHOP regimens as first-line therapy in DLBCL patients with high Ki-67 expression. Data from 44 untreated DLBCL patients with high Ki-67 expression receiving R-EPOCH therapy were matched with those from 132 untreated DLBCL patients with high Ki-67 expression receiving R-CHOP therapy based on the International Prognostic Index (IPI: age, Ann Arbor stage, performance status, LDH level, number of extranodal sites), gender, and Ki-67 expression. In the R-EPOCH group, 42/44 patients were eligible for response evaluation. A total of 35 patients (83.3%) achieved complete remission (CR); 6 patients (14.3%) achieved partial remission (PR); and one patient (2.4%) exhibited progressive disease (PD) after 2 cycles of therapy. Patients in the R-EPOCH group presented better survival outcomes than those in the R-CHOP group (3-year overall survival [OS]: 89.9% vs. 70.2%, p = 0.041; 3-year progression-free survival [PFS]: 86.6% vs. 59.7%, p = 0.024). The survival superiority of the R-EPOCH over the R-CHOP regimen persisted when considering only patients of low-to-intermediate IPI risk, but it was not observed in those of high IPI risk. Our data suggest that R-EPOCH could be superior to R-CHOP as a first-line regimen in DLBCL patients with high Ki-67 expression, especially in those of low-to-intermediate IPI risk.
Highlights
Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma (NHL), accounting for 30%–40% of all NHL patients [1,2,3]
This study aims to compare the R-EPOCH and R-CHOP regimens as first-line therapy in DLBCL patients with high Ki-67 expression
Data from 44 untreated DLBCL patients with high Ki-67 expression receiving R-EPOCH therapy were matched with those from 132 untreated DLBCL patients with high Ki-67 expression receiving R-CHOP therapy based on the International Prognostic Index (IPI: age, Ann Arbor stage, performance status, lactate dehydrogenase (LDH) level, number of extranodal sites), gender, and Ki-67 expression
Summary
Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma (NHL), accounting for 30%–40% of all NHL patients [1,2,3]. R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) is the first-line standard treatment for DLBCL because the addition of rituximab to CHOP chemotherapy notably improves survival outcomes [6, 7]. Some DLBCL patients continue to present an inferior prognosis under standard R-CHOP therapy. For tumors with high proliferation, the EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin) regimen is based on the concept that the extension of drug exposure may yield better antitumor efficacy than a bolus regimen, such as CHOP [11,12,13]. We found that DLBCL patients with high Ki-67 expression received limited survival benefits from R-CHOP therapy [16]. The present study aimed to investigate whether R-EPOCH is superior to R-CHOP in untreated DLBCL patients with high Ki-67 expression
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call