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Ferrata Storti Foundation
Haematologica 2021 Volume 106(3):730-735
Non-Hodgkin Lymphoma
Response-adapted therapy with infusional EPOCH chemotherapy plus rituximab in human immunodeficiency virus-associated, B-cell non-Hodgkin lymphoma
Joseph A. Sparano,1 Jeannette Y. Lee,2 Lawrence D. Kaplan,3 Juan Carlos Ramos,4 Richard F. Ambinder,5 William Wachsman,6,7 David Aboulafia,8 Ariela Noy,9,10 David H. Henry,11 Lee Ratner,12 Ethel Cesarman,10 Amy Chadburn10 and Ronald Mitsuyasu13
1Montefiore-Einstein Cancer Center, Montefiore Medical Center, Bronx, NY; 2University of Arkansas for Medical Sciences, Little Rock, AR; 3University of California San Francisco, San Francisco, CA 4University of Miami, Miami, FL; 5Sidney Kimmel Cancer Center at Johns Hopkins, Baltimore, MD; 6Moores Cancer Center University of California San Diego, La Jolla, CA; 7Veterans Affairs San Diego Healthcare System, San Diego, CA; 8Virginia Mason Cancer Institute, Seattle, WA; 9Memorial Sloan Kettering Cancer Center, New York, NY; 10Weill Cornell Medical College, New York, NY; 11Pennsylvania Hospital, Philadelphia, PA; 12Washington University, St. Louis, MO and 13University of California Los Angeles Medical Center, Los Angeles, CA, USA. All the institutes are part of the AIDS Malignancy Consortium.
ABSTRACT
Four cycles of rituximab plus CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy is as effective as six cycles in low-risk diffuse large B-cell lymphoma (DLBCL). Here we report a post-hoc analysis of a prospective clinical trial in patients with human immunodeficiency virus-associated DLBCL and high-grade lymphoma treated with four to six cycles of EPOCH plus rituximab based on a response-adapted treatment strategy. One hundred and six evaluable patients with human immunodeficiency virus-associated DLBCL or high- grade CD20+ non-Hodgkin lymphoma were randomized to receive ritux- imab (375 mg/m2) given either concurrently prior to each infusional EPOCH cycle, or sequentially (weekly for 6 weeks) following completion of EPOCH. EPOCH consisted of a 96-hour intravenous infusion of etopo- side, doxorubicin, and vincristine plus oral prednisone followed by an intravenous bolus of cyclophosphamide every 21 days for four to six cycles. Patients received two additional cycles of therapy after documen- tation of a complete response by computed tomography after cycles 2 and 4. Sixty-four of 106 evaluable patients (60%; 95% confidence interval [95% CI]: 50%-70%) in both treatment arms had a complete response. The 2-year event-free survival rates were similar in the 24 patients with complete response who received four or fewer cycles of EPOCH (78%; 95% CI: 55%-90%) due to having achieved a complete response after two cycles, compared with those who received five or six cycles of EPOCH (85%; 95% CI: 70%-93%) because a complete response was first documented after cycle 4. A response-adapted strategy may permit a shorter treatment duration without compromising therapeutic efficacy in patients with human immunodeficiency virus-associated lymphoma treated with EPOCH plus rituximab, which merits further evaluation in additional prospective trials. Clinical Trials.gov identifier NCT00049036.
Introduction
Six cycles of the anti-CD20 antibody rituximab (R) plus cyclophosphamide, dox- orubicin, vincristine, and prednisone (CHOP) or CHOP-like chemotherapy are rec- ommended by the European Society of Medical Oncology (ESMO) and National Comprehensive Cancer Network (NCCN) practice guidelines for the treatment of diffuse large B-cell lymphoma (DLBCL),1,2 a recommendation supported by popu-
Correspondence:
JOSEPH A. SPARANO
jsparano@montefiore.org
Received: November 19, 2019. Accepted: February 25, 2020. Pre-published: February 27, 2020.
https://doi.org/10.3324/haematol.2019.243386
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