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R‐ CHOP versus dose‐adjusted R‐ EPOCH in frontline management of primary mediastinal B‐cell lymphoma: a multi‐centre analysis
Author(s) -
Shah Nirav N.,
Szabo Aniko,
Huntington Scott F.,
Epperla Narendranath,
Reddy Nishitha,
Ganguly Siddhartha,
Vose Julie,
Obiozor Cynthia,
Faruqi Fahad,
Kovach Alexandra E.,
Costa Luciano J.,
Xavier Ana C.,
Okal Ryan,
Kanate Abraham S.,
Ghosh Nilanjan,
KharfanDabaja Mohamed A.,
Strelec Lauren,
Hamadani Mehdi,
Fenske Timothy S.,
Calzada Oscar,
Cohen Jonathon B.,
Chavez Julio,
Svoboda Jakub
Publication year - 2018
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.15051
Subject(s) - medicine , epoch (astronomy) , vincristine , rituximab , chop , prednisone , etoposide , cyclophosphamide , lymphoma , regimen , chemotherapy , gastroenterology , surgery , oncology , stars , physics , astronomy
Summary Primary mediastinal (thymic) large B‐cell lymphoma ( PMBCL ) is an uncommon subtype of non‐Hodgkin lymphoma ( NHL ) that presents with a mediastinal mass and has unique clinicopathological features. Historically, patients with PMBCL were treated with R‐ CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy ± involved field radiation. Since a phase II trial, published in April 2013, demonstrated excellent results using dose‐adjusted ( DA ) R‐ EPOCH (rituximab, etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin), this treatment has gained popularity. We performed a retrospective, multicentre analysis of patients aged ≥18 years with PMBCL since January 2011. Patients were stratified by frontline regimen, R‐ CHOP versus DA ‐R‐ EPOCH . 132 patients were identified from 11 contributing centres (56 R‐ CHOP and 76 DA ‐R‐ EPOCH ). The primary outcome was overall survival. Secondary outcomes included progression‐free survival, complete response ( CR ) rate, and rates of treatment‐related complications. Demographic characteristics were similar in both groups. DA ‐R‐ EPOCH use increased after April 2013 (79% vs. 45%, P < 0·001), and there was less radiation use after DA ‐R‐ EPOCH (13% vs. 59%, P < 0·001). While CR rates were higher with DA ‐R‐ EPOCH (84% vs. 70%, P = 0·046), these patients were more likely to experience treatment‐related toxicities. At 2 years, 89% of R‐ CHOP patients and 91% of DA ‐R‐ EPOCH patients were alive. To our knowledge, this represents the largest series comparing outcomes of R‐ CHOP to DA ‐R‐ EPOCH for PMBCL .