DA-REPOCH Versus R-CHOP for the Treatment of Activated B-Cell Subtype Diffuse Large B-Cell Lymphoma: A Community Center Experience

Abstract

Diffuse large B-cell lymphoma (DLBCL) represents around one quarter of non-Hodgkin lymphomas in both the United States and globally. The activated B-cell (ABC) subtype of DLBCL is associated with higher relapse rates and a worse prognosis when treated with standard regimens in comparison to other subtypes of DLBCL. Recent studies have demonstrated a potential benefit with combination of dose-adjusted rituximab, etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (DA-REPOCH) in comparison to standard combination chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) in ABC DLBCL patients. We aimed to see if there was any benefit on progression-free survival (PFS) and overall survival (OS) in a pooled patient population from a community oncology practice with the use of DA-REPOCH in ABC DLBCL. Our study did not reveal a statistically significant advantage in either PFS or OS with DA-REPOCH; however, a smaller percentage or patients progressed or relapsed when treated with DA-REPOCH. While the toxicity profile was similar, a higher percentage of patients receiving R-CHOP experienced grade 3 or higher toxicities. A prospective trial of R-CHOP versus DA-REPOCH in patients with the ABC subtype of DLBCL is warranted to further determine a potential benefit to DA-REPOCH in this patient population.

Outcomes of patients with double/triple expressor diffuse large B-cell lymphoma (DLBCL) treated with R-DA-EPOCH/R-CHOP: A single-center experience.

“…In keeping with this, the treatment of DLBCLs is under extensive research. Half a century ago, the standard of treatment regimen was a combination of chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) [7] . This regimen resulted in response rates of 45–55%, with 30–40% of patients achieving cure [ 7 , 8 ].…”

“…Half a century ago, the standard of treatment regimen was a combination of chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) [7] . This regimen resulted in response rates of 45–55%, with 30–40% of patients achieving cure [ 7 , 8 ]. Despite the advent of newer regimens, CHOP remained the mainstay of therapy for decades because of superior cure rates and lesser toxicity [8] .…”

“…Considering this, newer regimens are being investigated to improve survival. One such combination is dose-adjusted rituximab, etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (DA-REPOCH) [7] . However, studies comparing the effectiveness of R-CHOP with that of DA-REPOCH have been inconclusive.…”

“…Yet, Knouse et al. reported that while there was no improvement in survival between the two treatments, fewer patients in the DA-REPOCH arm relapsed or progressed after treatment [7] , suggesting that the benefits of this new treatment must be re-evaluated.…”