DA-R-EPOCH versus R-CHOP in intermediate and high risk IPI diffuse large B-cell lymphoma, a randomized controlled trial

Abstract

Background: Diffuse large B-cell lymphoma is a challenging disease in management. Although most patients are cured with the standard R-CHOP, one third of them remains refractory to this regimen. As prognosis of refractory disease is worse than primarily responding one, several trials investigated other more intense frontline regimens tailored based upon risk and biological characteristics. Patients & Methodology: This is a prospective randomized trial investigating the more intensive DA-R-EPOCH regimen as frontline therapy in intermediate and high risk DLBCL patients in comparison to the standard R-CHOP regimen. We compared both regimens in these risk categories as well as undergoing a subgroup analysis according to cell of origin (Germinal center versus activated B cell) and according to BCL2 and C-myc expression (double expressor lymphoma). Toxicities in both arms have been analyzed according to common terminology criteria for adverse events (CTCAE). Results: In spite of being more toxic and complex, there was no significant improvement in DFS or response rate with DA-R-EPOCH. No significant benefit for DA-R-EPOCH over R-CHOP in both germinal center and activated B-cell DLBCL. Conclusion: Tailoring upfront treatment of DLBCL based upon risk classification or BCL2/c-myc expression remains an area of unanswered questions and warrants further investigations.