A Study of Dose-Adjusted EPOCH Chemotherapy in Diffuse Large B-Cell Lymphoma

ABSTRACT

Background: Worldwide, diffuse large B-cell lymphoma (DLBCL) represents the most common subtype of non-Hodgkin lymphoma (NHL), accounting for 30%-40% of all newly diagnosed cases. The response rate to currently available chemotherapy in DLBCL is much unsatisfactory. Dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin (DA-EPOCH) was developed in an effort to improve outcome in patients with diffuse large B-cell lymphoma. To assess the efficacy and safety of DA-EPOCH chemotherapy in patients with diffuse large B-cell lymphomas.Material & Methods:This quasi experimental study was conducted in the department of Hematology, DMCH, from January 2016 to December 2017. 20 patients with diffuse large B-cell lymphomas were treated with etoposide, vincristine, and doxorubicin for 96 hours with bolus doses of cyclophosphamide and oral prednisone (DA-EPOCH chemotherapy). The doses of etoposide, doxorubicin and cyclophosphamide were adjusted to achieve a nadir absolute neutrophil count below 0.5× 109/L. Cycles were repeated after 21 days. After 3rd and 6th cycle patients were evaluated for interim analysis and response evaluation respectively. Evaluation was done in aspect of clinical parameter (lymph node size, physical complaint), laboratory parameter (CBC) and radiological imaging (CT scan of chest and abdomen). The median age of the patient was 46.5 years (range, 25-62 years); 20% were older than 50 years; and 25% were at high-intermediate risk according to International Prognostic Index (IPI) criteria. The statistical analyses were done by appropriate methods.Results:There was a complete response in 73.7% of patients and partial response 10.5% of patients, which were evidenced by significant reduction of size of the lymph nodes after chemotherapy. The mean Serum LDH was also significantly lower after chemotherapy in comparison to before chemotherapy in those patients who achieved complete or partial response. Moreover, size of the liver and spleen were significantly lower after chemotherapy in response group patients who had either hepatomegaly or splenomegaly or both. Doses were escalated in 12.50% cycles and toxicity levels were acceptable.Conclusion:DA-EPOCH chemotherapy is an effective regimen for treatment of diffuse large B-cell lymphoma patients.