ABCL-338 Impact of DA-R-EPOCH for High-Grade B-Cell Lymphoma Patients at the University of Michigan

Abstract

Historically, high-grade B-cell lymphomas (HGBCL) have an inferior prognosis and respond poorly to standard upfront R-CHOP. Implementation of an intensified regimen with dose-adjusted R-EPOCH (DA-R-EPOCH) is our institutional standard of care as it allows for pharmacodynamic dose adjustments to maximize dose with the goal of attaining maximal response. Whether dose adjustments truly impact the achievement and durability of responses is unclear. To investigate the clinical characteristics and outcomes of patients with HGBCL treated at the University of Michigan who received DA-R-EPOCH. Retrospective cohort study of HGBCL patients treated with DA-R-EPOCH at the University of Michigan from 2007 to 2021. Descriptive statistics with univariate and multivariate analysis and survival analyses were performed. University of Michigan Hospital. Patients (≥18 years old) with HGBCL (defined by MYC rearrangement detected by FISH or conventional cytogenetics, along with either BCL-2 and/or BCL-6 rearrangements) who received induction chemotherapy with DA-R-EPOCH at the University of Michigan were selected for inclusion (n=44 patients). The primary outcome was overall survival (OS), defined as the time from diagnosis to death or last follow-up and estimated with Kaplan-Meier analysis. Secondary outcomes include overall response rate (ORR), defined as complete or partial response after induction therapy. Forty-four patients were included (50% male) with a median age at diagnosis of 64 years. The majority of patients had stage III/IV disease at diagnosis (75%). Transformed diffuse large B-cell lymphoma accounted for 23% of patients with the majority being follicular lymphoma. Most patients (84.1%) had BCL2 rearrangement, 38.6% had BCL6 rearrangement, and 22.7% had both. All patients received induction with DA-R-EPOCH, though dose escalations were only made for 59% of patients. Dose levels varied from dose level -1 to dose level 5, though most patients (39%) were maximized at dose level 1. ORR was 73% across the entire cohort. The median overall survival was 42 months (95% CI: 16, NR). Outcomes among HGBCL patients managed at the University of Michigan were favorable, though interestingly, not all patients received true dose escalations. Future directions will involve assessing whether dose escalations of this regimen are truly instrumental in improving survival outcomes.