|Title||Response-adapted therapy with infusional EPOCH chemotherapy plus rituximab in HIV-associated, B-cell non-Hodgkin's lymphoma.|
|Publication Type||Journal Article|
|Year of Publication||2021|
|Authors||Sparano 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 Published||2021 03 01|
|Keywords||Antineoplastic 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 Trials.gov identifier NCT00049036.
|PubMed Central ID||PMC7927888|
|Grant List||P30 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
Related Faculty:Amy Chadburn, M.D. Ethel Cesarman, M.D., Ph.D.