Managing relapsed refractory lymphoma with palliative oral chemotherapy: A multicentre retrospective study

Abstract

PEP-C (prednisolone, etoposide, procarbazine and cyclophosphamide) is an orally administered daily chemotherapy regimen used with palliative intent in relapsed refractory lymphoma. To our knowledge, no data on PEP-C have been reported since the original group described the regimen. Here we present a multicentre retrospective cohort reporting our use of PEP-C in 92 patients over an 8-year period. We find that even heavily pretreated lymphoma can respond to PEP-C, particularly low-grade lymphoma (including mantle cell) and lymphoma that was sensitive to the previous line of systemic therapy (chemosensitive). These characteristics may help in the selection of patients likely to derive benefit. The median overall survival of patients with chemosensitive lymphoma treated with PEP-C is 217 days. Within the limitations of a retrospective cohort, we find that PEP-C is well tolerated: the most common toxicity leading to discontinuation is marrow suppression. We suggest that PEP-C should be considered for patients with relapsed refractory lymphoma in two settings: first, where there is no licensed alternative; and second, where the licensed alternative is an intravenous drug and the patient would prefer to choose an oral chemotherapy option.

FIGURE 1

Kaplan‐Meier survival estimate of overall survival from starting treatment with PEP‐C. (A) All patients. Median overall survival = 163 days (95% CI: 95 to 230). (B) Survival estimates grouped by histological diagnosis. Patients with low‐grade disease had a median overall survival of 409 days (95% CI: 163 to 599) versus 100 days (95% CI: 77 to 163) for patients with high‐grade disease. HR = 0.35 (95% CI: 0.19 to 0.63); p < 0.001. (C) Survival estimates grouped by the response a patient made to the line of systemic treatment prior to PEP‐C. Patients who were chemosensitive had a median overall survival of 217 days (95% CI: 98 to 465) versus 100 days (95% CI: 45 to 163) for patients who were chemoresistant. HR = 0.36 (95% CI: 0.21 to 0.62); p < 0.001