Response-adapted therapy with infusional EPOCH chemotherapy plus rituximab in HIV-associated, B-cell non-Hodgkin's lymphoma.

TitleResponse-adapted therapy with infusional EPOCH chemotherapy plus rituximab in HIV-associated, B-cell non-Hodgkin's lymphoma.
Publication TypeJournal Article
Year of Publication2021
AuthorsSparano JA, Lee JY, Kaplan LD, Ramos JCarlos, Ambinder RF, Wachsman W, Aboulafia D, Noy A, Henry DH, Ratner L, Cesarman E, Chadburn A, Mitsuyasu R
Date Published2021 03 01
KeywordsAntineoplastic Combined Chemotherapy Protocols, B-Lymphocytes, Cyclophosphamide, Doxorubicin, Etoposide, HIV Infections, Humans, Lymphoma, Large B-Cell, Diffuse, Lymphoma, Non-Hodgkin, Prednisone, Prospective Studies, Rituximab, Vincristine

Four cycles of rituximab plus CHOP chemotherapy is as effective as 6 cycles in low-risk diffuse large B-cell lymphoma (DLBCL). Here we report a post-hoc analysis of a prospective clinical trial in patients with HIV-associated DLBCL and high-grade lymphoma treated with 4-6 cycles of EPOCH plus rituximab based a response-adapted treatment strategy. 106 evaluable patients with HIV-associated DLBCL or high-grade CD20-positive non-Hodgkin's lymphoma were randomized to receive rituximab (375 mg/m2) given either concurrently prior to each infusional EPOCH cycle, or sequentially (weekly for 6 weeks) following completion of EPOCH. EPOCH consisted of a 96-hour IV infusion of etoposide, doxorubicin, and vincristine plus oral prednisone followed by IV bolus cyclophosphamide every 21 days for 4 to 6 cycles. Patients received 2 additional cycles of therapy after documentation of a complete response (CR) by computerized tomography after cycles 2 and 4. 64 of 106 evaluable patients (60%, 95% CI 50%, 70%) had a CR in both treatment arms. The 2-year event-free survival (EFS) rates were similar in the 24 patients with CR who received 4 or fewer EPOCH cycles (78%, 95% confidence intervals [55%, 90%]) due to achieving a CR after 2 cycles, compared with those who received 5-6 cycles of EPOCH (85%, 95% CI 70%, 93%) because a CR was first documented after cycle 4. A response-adapted strategy may permit a shorter treatment duration without compromising therapeutic efficacy in patients with HIV-associated lymphoma treated with EPOCH plus rituximab, which merits further evaluation in additional prospective trials. Clinical identifier NCT00049036.

Alternate JournalHaematologica
PubMed ID32107337
PubMed Central IDPMC7927888
Grant ListP30 AI094189 / AI / NIAID NIH HHS / United States
P30 CA008748 / CA / NCI NIH HHS / United States
U01 CA121947 / CA / NCI NIH HHS / United States
UM1 CA121947 / CA / NCI NIH HHS / United States
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Amy Chadburn, M.D. Ethel Cesarman, M.D., Ph.D.

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