Cost Analysis of R-CHOP Versus Dose-Adjusted R-EPOCH in Treatment of Diffuse Large B-Cell Lymphoma with High-Risk Features

Abstract

Dose-adjusted rituximab, etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin (DA.R-EPOCH) is used for upfront treatment of high-risk diffuse large B cell lymphoma (DLBCL). In this study, we compared the outcomes in patients with high-risk DLBCL who received frontline rituximab, cycophosphamide, doxorubicin, vincristine, prednisone (R-CHOP) or DA.R-EPOCH immunochemotherapy. Outcomes and treatment-related cost were analyzed. DLBCL with one of the following features were included in the study: MYC ± BCL2 or BCL6 rearrangement by FISH or MYC overexpression by immunohistochemistry, Ki67 index ≥ 80% or nongerminal center immunophenotype, tumor measuring ≥5 cm and NCCN-IPI score ≥4. A total of 80 patients were treated with R-CHOP (n = 52, 65%) or DA.R-EPOCH (n = 28, 35%), with a median follow-up of 11.2 months (range: 0.7-151.3 months). The hazard ratios (HRs) for progression-free survival and overall survival were 0.79 [95% confidence interval (CI) 0.28%-2.29%, p = 0.67] and 0.86 (95% CI 0.26%-2.78%, p = 0.80), respectively for DA.R-EPOCH compared to R-CHOP. The total mean cost was USD106,940 ± USD39,351 and USD58,509 ± 24,588 for DA.R-EPOCH and R-CHOP respectively (p < 0.001). In our analysis, DA.R-EPOCH resulted comparable clinical outcomes and increased treatment-related expenses compared to R-CHOP in high-risk DLBCL.

Outcome of diffuse large B-cell lymphoma patients treated with different chemotherapeutic regimens (R-DA-EPOCH vs R-CHOP)

“…17 Another study showed that, longitudinal cohort of 80 patients with high-risk DLBCL, 52 (65%) were treated with R-CHOP and 28 (35%) received DA-R-EPOCH.Most patients (71%) were e"60 years of age. 18 In this study, most patients had stage III or IV disease, 70.0% in R-CHOP group and 67% in R-DA-EPOCH group. Another study described that most of the patients had stage III or IV disease (74.0%).…”

“…It was described in another study that that,86.1% of their patients had IPI score of less than 4 in R-CHOP group and 79.2% of patients in R-DA-EPOCH group. 18 In this study, all six chemotherapy cycles were completed by 90.0% of the R-CHOP and 78.0% of the DA-EPOCH-R group. Reasons for early discontinuation included disease progression (R-DA-EPOCH, 10%).…”

Toxicities Associated With Dose-Adjusted Epoch-R Compared With R-Chop as Frontline Therapy for Diffuse Large B-Cell Lymphoma: A Study Conducted in a Tertiary Level Hospital of Bangladesh

“…In terms of age, 19.0% of patients (n = 93) were at least 70 years old and 2.6% (n = 13) were 80 years or older. 17 Another study described that,longitudinal cohort of 80 patients with high-risk DLBCL,52 (65%) were treated with R-CHOP and 28 (35%) received DA.REPOCH. Most patients (71%) were e"60 years of age.…”

“…18 Another study described that most of the patients had stage III or IV disease (74.0%). 17 Another study described that, on retrospective analysis, treatment of patients with high-risk DLBCL with DA.R-EPOCH resulted in similar clinical outcomes, but was associated with increased incidence of grade 3/4 neutropenia and need for transfusions during treatment when compared to those receiving R-CHOP regimen. 19 The more intensive, infusional DA-EPOCH-R was more toxic and did not improve progression free survival (PFS) or overall survival (OS) compared with R-CHOP.…”

Practicing Clinical Hematology During the COVID-19 Outbreak: A Challenge Like No Other

“…In this new issue of Clinical Hematology International , you will read some high-level clinical reviews [ 2 , 3 ] and original reports [ 4 – 5 ], in addition to a diverse set of material. We hope you will continue to enjoy the IACH activities.…”