DA-REPOCH Versus R-CHOP for the Treatment of Activated B-Cell Subtype Diffuse Large B-Cell Lymphoma: A Community Center Experience.

Phillip Knouse,Jacob Bitran,Ronald L Sirota,Edward Nabrinsky,David Hakimian

doi:10.7759/cureus.11714

Abstract

Diffuse large B-cell lymphoma (DLBCL) represents around one quarter of non-Hodgkin lymphomas in both the United States and globally. The activated B-cell (ABC) subtype of DLBCL is associated with higher relapse rates and a worse prognosis when treated with standard regimens in comparison to other subtypes of DLBCL. Recent studies have demonstrated a potential benefit with combination of dose-adjusted rituximab, etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (DA-REPOCH) in comparison to standard combination chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) in ABC DLBCL patients. We aimed to see if there was any benefit on progression-free survival (PFS) and overall survival (OS) in a pooled patient population from a community oncology practice with the use of DA-REPOCH in ABC DLBCL. Our study did not reveal a statistically significant advantage in either PFS or OS with DA-REPOCH; however, a smaller percentage or patients progressed or relapsed when treated with DA-REPOCH. While the toxicity profile was similar, a higher percentage of patients receiving R-CHOP experienced grade 3 or higher toxicities. A prospective trial of R-CHOP versus DA-REPOCH in patients with the ABC subtype of DLBCL is warranted to further determine a potential benefit to DA-REPOCH in this patient population.

Highlights

Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma, representing 21% of all non-Hodgkin lymphomas diagnosed in United States from 2008 to 2017 [1]
We identified 21 patients with the activated B-cell (ABC) subtype who had been treated with either R-CHOP or DA-REPOCH
In our retrospective analysis of 21 patients with the ABC subtype of DLBCL, 33% of patients treated with rituximab to standard CHOP therapy (RCHOP) either progressed or relapsed, whereas none of the patients treated with DA-REPOCH progressed or relapsed (p = 0.1038)

Summary

Introduction

Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma, representing 21% of all non-Hodgkin lymphomas diagnosed in United States from 2008 to 2017 [1]. Treatment of aggressive lymphomas with CHOP resulted in complete response rates of 45%-55% and cured approximately 30%-40% of patients [2,4,5]. CHOP remained the standard of care for these patients throughout the 1990s, despite the development of later generation combination chemotherapy regimens such as methotrexate, bleomycin, doxorubicin, cyclophosphamide, vincristine, dexamethasone (m-BACOD); prednisone, methotrexate, doxorubicin, cyclophosphamide, etoposide plus cytarabine, bleomycin, vincristine, methotrexate (ProMACE-CytaBOM); and methotrexate, doxorubicin, cyclophosphamide, vincristine, prednisone (MACOP) as these regimens did not improve response rates or survival and were more toxic [4]. The addition of rituximab to standard CHOP therapy (RCHOP) in the early 2000s was a major stride in the treatment of DLBCL as it resulted in improved response rates and survival compared to CHOP alone, without significant toxicity [5,6]. The non-germinal center subtype includes the activated B-cell (ABC) subtype [7]

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