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K. Miyazaki et al.
nificant difference in survival between patients who received R-CHOP and patients who received DA-EPOCH- R in a large randomized controlled trial.28 In that trial, the prognosis stratified by CD5 was not shown. In the largest study including 130 DLBCL patients who were examined for CD5 expression and received DA-EPOCH-R, 16 (12.3%) patients had CD5+ DLBCL.29 At a median follow up of 28.5 months, 37.5% of patients in the CD5+ DLBCL group had died, which showed a significantly worse sur- vival than those in the CD5- DLBCL. The 2-year OS was 89% (90%CI: 79-95%; 95%CI: 76-95%) for DA-EPOCH- R/HD-MTX in our present trial.
In a large retrospective study including 102 patients with CD5+ DLBCL, 6 of 7 patients with untreated CD5+ DLBCL who received DA-EPOCH-R achieved a CR and
were disease-free with a median follow up of 30 months.10 In another study, CD5 expression in DLBCL was identi- fied as a risk factor for short OS in a cohort of patients who received R-EPOCH,29 which indicated that R-EPOCH alone may be insufficient to cure this disease. In the pres- ent study of stage II-IV CD5+ DLBCL, HD-MTX therapy was added between the fourth and fifth cycles of DA- EPOCH-R. In our trial, the completion rate of the protocol treatment was high. Moreover, there were no deviations or violations in the dose-adjustment of DA-EPOCH-R. All patients received DA-EPOCH-R/HD-MTX only in the hospital. These features may have contributed to the excellent efficacy of DA-EPOCH-R/HD-MTX in our trial. However, a considerable number of female patients (62%), patients with PS <2 (96%), and those with
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Figure 2. Survival curves for patients with CD5-positive diffuse large B-cell lymphoma. (A) Progression-free survival and (B) overall survival for all patients (n=47).
Figure 3. Central nervous system (CNS) relapse in CD5-positive diffuse large B-cell lymphoma patients (n=47). (A) Probability of CNS relapse. (B) Probability of CNS relapse according to the CNS-International Prognostic Index.
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haematologica | 2020; 105(9)