| Abstract: |
Background A phase II trial of dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin and rituximab (DA-EPOCH-R) from the National Cancer Institute showed promising activity in untreated diffuse large B-cell lymphoma. The Cancer and Leukemia Group B conducted a study to determine if these results could be reproduced in a multi-institutional setting. Design and Methods The study included 69 patients with untreated diffuse large B-cell lymphoma at least 18 years of age and at least stage II. Radiaton therapy was not permitted on study. Median age was 58 years (range 23-83) and 40% had high-intermediate or high International Prognostic Index risk. Immunohistochemical biomarkers for cell of origin and proliferation were performed. Results With a median follow up of 62 months, time to progression and overall survival were 81% and 84%, respectively, and time to progression was 87%, 92% and 54% for low/low-intermediate, high-intermediate and high International Prognostic Index risk groups, respectively, at 5-years and beyond. The time to progression and event-free survival of germinal center B-cell lymphoma were 100% and 94%, respectively, and non-germinal center B-cell GCB diffuse large Bcell lymphoma were 67% and 58%, respectively, at 62 months (germinal center vs. non-germinal center B cell P=0.008). DA-EPOCH-R was tolerated without significant grade 4 non-hematologic toxicities. Conclusions These results provide the first confirmation by a multi-institutional group that DA-EPOCH-R provides high durable remissions in diffuse large B-cell lymphoma and is effective in both germinal center and non-germinal center B-cell subtypes. © 2012 Ferrata Storti Foundation. |
| Keywords: |
adult; event free survival; human tissue; treatment response; aged; aged, 80 and over; middle aged; survival rate; young adult; major clinical study; overall survival; prednisone; disease course; fatigue; neutropenia; doxorubicin; methotrexate; rituximab; follow up; follow-up studies; neoplasm staging; ki 67 antigen; protein bcl 2; multiple cycle treatment; phase 2 clinical trial; sensory neuropathy; etoposide; mucosa inflammation; antineoplastic combined chemotherapy protocols; tumor markers, biological; cyclophosphamide; vincristine; drug dose escalation; fever; immunoenzyme techniques; cd20 antigen; multicenter study; remission induction; nausea and vomiting; lactate dehydrogenase; protein bcl 6; large cell lymphoma; lymphoma, large b-cell, diffuse; heart arrhythmia; erythrocyte transfusion; cotrimoxazole; mediastinal neoplasms; brain hemorrhage; interferon regulatory factor 4; thrombocyte transfusion; diffuse large b-cell lymphoma; motor neuropathy; common acute lymphoblastic leukemia antigen; molecular; untreated; antibodies, monoclonal, murine-derived; da-epoch-rituximab; outome; lim protein
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