Chemoimmunotherapy Regimen Confers Benefit in Double Expressor DLBCL

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Patients younger than 65 with double expressor diffuse large B-cell lymphoma had better outcomes with dose-adjusted EPOCH plus rituximab than R-CHOP.
Patients younger than 65 with double expressor diffuse large B-cell lymphoma had better outcomes with dose-adjusted EPOCH plus rituximab than R-CHOP.

Patients aged younger than 65 years with double expressor diffuse large B-cell lymphoma (DE DLBCL) had better outcomes with dose-adjusted EPOCH plus rituximab (DA-EPOCH-R) than R-CHOP, a retrospective analysis revealed. The study findings were published online January 10, 2019, in Leukemia.

DLBCL patients with double expression of MYC and BCL2 have a “dismal prognosis,” the study authors wrote, and no standard therapy exists, representing an “urgent unmet clinical need.”

Study authors retrospectively compared the outcomes of patients with DE DLBCL treated with DA-EPOCH-R versus those treated with R-CHOP. The primary objective was to compare 2-year progression-free survival (PFS) and overall survival (OS) for each treatment regimen. 

A total of 114 patients were included in the study; 51 patients in the DA-EPOCH-R group and 63 patients in the R-CHOP group. 

The DA-EPOCH-R group had an overall response rate (ORR) of 80%, with 37 patients (73%) achieving complete response (CR) and 4 patients (7%) achieving partial response (PR). The R-CHOP group had an ORR of 76%, with 44 patients (71%) achieving CR and 4 patients (9%) achieving PR. 

No statistically significant differences for 2-year PFS or OS were seen between treatment groups. However, when a subgroup analysis was performed on the basis of age, a difference emerged.

Patients in the DA-EPOCH-R group aged younger than 65 years had a longer 2-year PFS rate than the patients in the R-CHOP group (PFS = 82%; 95% CI, 66%-100% vs PFS = 43%; 95% CI, 26%-73%; P = .020). The patients in the DA-EPOCH-R group aged younger than 65 years also had a longer 2-year OS rate than those in the R-CHOP group (OS = 90%; 95% CI, 74%-100% vs OS = 62%; 95% CI, 43%-88%; P = .042). 

“The results of the present study suggest that intensive chemotherapy, such as DA-EPOCH-R, should be considered for patients with DE DLBCL aged less than 65 years,” the study authors wrote in conclusion. 

Reference

  1. Dodero A, Guidetti A, Tucci A, et al. Dose-adjusted EPOCH plus rituximab improves the clinical outcome of young patients affected by double expressor diffuse large B-cell lymphoma [published online January 10, 2019]. Leukemia. doi: 10.1038/s41375-018-0320-9

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