Clinical study of DA-EPOCH regimen combined with or without rituximab in treatment of young newly diagnosed patients with middle and high-risk diffuse large B-cell lymphoma

Abstract

Objective To observe the clinical efficacy and prognosis of DA-EPOCH regimen combined with or without rituximab [(R)-DA-EPOCH regimen] in treatment of young newly diagnosed patients with middle and high-risk diffuse large B-cell lymphoma (DLBCL). Methods The clinical data of 107 young newly diagnosed middle to high-risk DLBCL patients treated with (R)-DA-EPOCH regimen at Guizhou Cancer Hospital between November 2014 and December 2018 were retrospectively analyzed. The efficacies were analyzed by grouping according to rituximab (65 cases in R-DA-EPOCH group and 42 cases in DA-EPOCH group), and according to involved-filed radiotherapy (IFRT) after chemotherapy (99 cases with chemotherapy indications including 59 cases with IFRT and 40 cases without IFRT). Results The objective response rate (ORR) was 86.0% (92/107). The 1-, 2-year overall survival (OS) rate was 90.6% and 75.3%. The 1-, 2-year progression-free survival (PFS) rate was 79.1% and 56.5%. The ORR, 1-year OS rate, 2-year OS rate, 1-year PFS rate and 2-year PFS rate in R-DA-EPOCH group were higher than those in DA-EPOCH group [87.7% (57/65) vs. 83.3% (35/42), 94.8% vs. 84.9%, 80.4% vs. 68.2%, 90.5% vs. 77.0%, 61.0% vs. 50.8%, respectively), but there were no statistical differences (all P > 0.05). The ORR of IFRT group and non-IFRT group was 98.2% (56/57) and 80.0% (32/40) (χ 2 = 7.225, P = 0.007). The 2-year OS rate was 86.0% and 63.3% (P < 0.05). Main adverse reactions caused by radiotherapy were local skin mucosa reactions of grade Ⅰ-Ⅱ [42.4% (25/59)]. Multivariate analysis showed that albumin value after treatment was an independent prognosis factor affecting OS rate (95% CI 2.709-21.433, P < 0.01). Gender (95% CI 0.020-0.318, P < 0.01), albumin level (95% CI 2.097-12.219, P < 0.01), Beta 2 microglobulin level (95% CI 0.080-0.602, P < 0.01) and absolute lymphocyte count/absolute monocyte count (95% CI 0.113-0.720, P < 0.01) after treatment were independent prognosis factors affecting PFS rate. Conclusions The young newly diagnosed patients with middle and high-risk DLBCL are highly heterogeneous. Rituximab combined with DA-EPOCH regimen can improve the efficacy of patients. IFRT after chemotherapy may increase the short-term efficacy and OS, and the adverse reactions are tolerant. Key words: Lymphoma, large B-cell, diffuse; Chemotherapy, adjuvant; Molecular targeted therapy; Young adult; Prognosis