Faculty Collaboration Database

R-CHOP versus dose-adjusted R-EPOCH in frontline management of primary mediastinal B-cell lymphoma: a multi-centre analysis. Br J Haematol 2018 Feb;180(4):534-544

Date

12/22/2017

Pubmed ID

29265182

DOI

10.1111/bjh.15051

Scopus ID

2-s2.0-85038422379 (requires institutional sign-in at Scopus site)   69 Citations

Abstract

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.

Author List

Shah NN, Szabo A, Huntington SF, Epperla N, Reddy N, Ganguly S, Vose J, Obiozor C, Faruqi F, Kovach AE, Costa LJ, Xavier AC, Okal R, Kanate AS, Ghosh N, Kharfan-Dabaja MA, Strelec L, Hamadani M, Fenske TS, Calzada O, Cohen JB, Chavez J, Svoboda J

Authors

Timothy Fenske MD Professor in the Medicine department at Medical College of Wisconsin
Mehdi H. Hamadani MD Professor in the Medicine department at Medical College of Wisconsin
Nirav N. Shah MD Associate Professor in the Medicine department at Medical College of Wisconsin
Aniko Szabo PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Antibodies, Monoclonal, Murine-Derived
Antineoplastic Combined Chemotherapy Protocols
Combined Modality Therapy
Cyclophosphamide
Disease Management
Doxorubicin
Etoposide
Female
Humans
Lymphoma, B-Cell
Male
Mediastinal Neoplasms
Middle Aged
Neoplasm Grading
Neoplasm Staging
Prednisone
Recurrence
Retrospective Studies
Rituximab
Treatment Failure
Treatment Outcome
Vincristine
Young Adult