Treatment of High Risk Aggressive B Cell Lymphomas with DA EPOCH R- a Retrospective Analysis

Background: Promising results in patients suffering from high risk DLBCL, Burkitt`s lymphoma (BL), gray-zone lymphoma (GZL) and primary mediastinal B cell lymphoma (PMBCL) treated with DA-EPOCH R have been reported.

In our centres high risk DLBCL - defined as double-hit/double hit score 2 or high/ high-intermediate risk NCCN IPI -, BL, MGZL and PMCL are treated with DA EPOCH R.

Methods: Retrospective analysis of toxicity and efficacy in DA EPOCH R treated patients.

Results: So far 39 previously untreated patients with a median age of 54a (28a - 76a) have been treated with a total of 190 cycles of DA EPOCH R: 16 DLBCL, 9 GZL, 8 PMBCL, 6 BL. 37 Patients have finished treatment, 2 are stilll on treatment.

Targeted ANC < 500/l occurred in 46%, thrombocytopenia < 25.000/l in 20% and anemia <8g/dl in 12,5% of all cycles. Dose escalation was possible in 27 (73%) patients - but only in 5 (38%) of 13 patients > 65a. 15 (63%) of 24 patients aged < 65a received at least dose level 3. Due to peripheral sensory neuropathy, Vincristine had to be dose reduced in 52% of all cycles. Other CTCAE grade III/IV non-hematopoietic toxicities were infrequent and manageable.

After a median follow up of 10 months (range: 1-25) overall survival (OS) rate is 74%. 2 patients in PR were (1 PMBCL, 1 GZL) bridged to allogenic stem cell transplantation , 1 patient in CR had to be switched to a less toxic regimen due to repeated febrile neutropenia after 3 cycles of treatment. In 16 high risk DLBCL patients (8 DHS2/DHL, 8 high/high intermediate NCCN IPI) OS is 80% after a median follow up of 12 month. As predescribed in literature, prognosis of relapsed or refractory patients is poor: 7 out of 8 (4GZL, 2 DLBCL, 1 BL, 1 PMBCL) relapsed/ refractory died. Causes of death were: 2 infectious complications (1 DLBCL HIV associated, 1 GZL) and 5 progressive disease.

Conclusion: Although still preliminary, limited data, DA EPOCH R seems to be a feasible treatment with acceptable toxicity and a promising response rate. Dose escalation is age dependent. Especially in patients with high risk DLBCL DA EPOCH R is an alternative to (insufficient) induction therapy with R CHOP and is challenging more toxic regimens like R ACVBP or R Hyper CVAD.