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Clinical Trial
. 2012 May;97(5):758-65.
doi: 10.3324/haematol.2011.056531. Epub 2011 Dec 1.

A Cancer and Leukemia Group B multi-center study of DA-EPOCH-rituximab in untreated diffuse large B-cell lymphoma with analysis of outcome by molecular subtype

Wyndham H Wilson  1 , Sin-Ho Jung, Pierluigi Porcu, David Hurd, Jeffrey Johnson, S Eric Martin, Myron Czuczman, Raymond Lai, Jonathan Said, Amy Chadburn, Dan Jones, Kieron Dunleavy, George Canellos, Andrew D Zelenetz, Bruce D Cheson, Eric D Hsi; Cancer Leukemia Group B
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Clinical Trial

A Cancer and Leukemia Group B multi-center study of DA-EPOCH-rituximab in untreated diffuse large B-cell lymphoma with analysis of outcome by molecular subtype

Wyndham H Wilson et al. Haematologica. 2012 May.

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 B-cell 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. The trial was registered at ClinicalTrials.Gov (NCT00032019).

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Figures

Figure 1.
Figure 1.
Kaplan-Meier plots of survival outcomes of all patients. Outcomes are reported at 5 years (95% Confidence Interval (CI)) and CI range is shown on the curves. (A) PFS 81% (69, 88). (B) EFS 75% (63, 84). (C) OS 84% (73, 91). (D) PFS for IPI risk groups: low/low-intermediate (------------------------) 87% (72, 94), high-intermediate (- - - - - - - - ) 92% (57, 99) and high risk (--- . . --- . . --- ) 54% (25, 76) (P=0.0085). (E) EFS for IPI risk groups: low/low-intermediate 85% (69, 93), high-intermediate 85% (51, 96) and high risk 43% (18, 66) (P<0.0013). (F) OS for IPI risk groups: low/low-intermediate 95% (80, 99), high-intermediate 92% (57, 99) and high risk 43% (18, 66) (P<0.0001).
Figure 2.
Figure 2.
Kaplan-Meier plots of survival outcomes patients with biomarkers. (A) PFS of GCB (-------------------------------) and non-GCB ( - - - - - - - - ) DLBCL (P=0.008). (B) EFS of GCB and non-GCB DLBCL (P=0.008). (C) OS of GCB and non-GCB DLBCL (P=0.04). (D) PFS of Ki67 < 60% (---------------------------) and Ki67 ≥ 60% ( - - - - - - - - - ) in non-GCB DLBCL (P=0.03). (E) EFS of Ki67 < 60% and Ki67 ≥ 60% in non-GCB DLBCL (P=0.04). (F) OS of Ki67 < 60% and Ki67 ≥ 60% in non-GCB DLBCL (P=0.05).
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References

    1. Fisher RI, Gaynor ER, Dahlberg S, Oken MM, Grogan TM, Mize EM, et al. Comparison of a standard regimen (CHOP) with three intensive chemotherapy regimens for advanced non-Hodgkin's lymphoma. N Engl J Med. 1993;328(14):1002–6. - PubMed
    1. Pfreundschuh M, Trumper L, Kloess M, Schmits R, Feller AC, Rudolph C, et al. Two-weekly or 3-weekly CHOP chemotherapy with or without etoposide for the treatment of young patients with good-prognosis (normal LDH) aggressive lymphomas: results of the NHL-B1 trial of the DSHNHL. Blood. 2004;104(3):626–33. - PubMed
    1. Pfreundschuh M, Trumper L, Kloess M, Schmits R, Feller AC, Rube C, et al. Two-weekly or 3-weekly CHOP chemotherapy with or without etoposide for the treatment of elderly patients with aggressive lymphomas: results of the NHL-B2 trial of the DSHNHL. Blood. 2004;104(3):634–41. - PubMed
    1. Coiffier B, Lepage E, Briere J, Herbrecht R, Tilly H, Bouabdallah R, et al. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med. 2002;346(4):235–42. - PubMed
    1. Pfreundschuh M, Trumper L, Osterborg A, Pettengell R, Trneny M, Imrie K, et al. CHOP-like chemotherapy plus rituximab versus CHOP-like chemotherapy alone in young patients with good-prognosis diffuse large-B-cell lymphoma: a randomised controlled trial by the MabThera International Trial (MInT) Group. Lancet Oncol. 2006;7(5):379–91. - PubMed

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