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.