DA-EPOCH-R improves the outcome over that of R-CHOP regimen for DLBCL patients below 60years, GCB phenotype, and those with high-risk IPI, but not for double expressor lymphoma

PurposeThis study was to compare DA-EPOCH-R and R-CHOP regimen as first-line therapy in diffuse large B cell lymphoma (DLBCL) patients, retrospectively.MethodsA total of 252 cases treated with R-CHOP and 146 cases who received DA-EPOCH-R were enrolled into this study.ResultsOverall, 162 (64.3%) and 105 patients (71.9%) achieved complete remission, 43 (17.1%) and 14 patients (9.6%) achieved partial remission following R-CHOP and DA-EPOCH-R regimen, respectively. After a median follow-up of 48months, better progression-free survival (PFS) was seen in DA-EPOCH-R group, but no better overall survival (OS) was found in patients treated with DA-EPOCH-R compared to R-CHOP (P=0.015 for PFS, P=0.19 for OS). However, subgroup analysis according to cell of origin, international prognostic index (IPI), and age showed DA-EPOCH-R resulted in significantly better PFS and OS than R-CHOP regimen in patients with germinal center B-cell-like (GCB) phenotype (P=0.002 for PFS, P=0.007 for OS), high IPI (P=0.002 for PFS; P=0.03 for OS), and with a younger age (P=0.002 for PFS, P=0.045 for OS). We also compared two regimens in patients with double expressor lymphoma (DEL). The prognosis of DEL patients was significantly worse than non-DEL patients (P<0.001 for PFS, P<0.001 for OS), but DA-EPOCH-R regimen may not overcome the poor prognosis (P=0.47 for PFS, P=0.79 for OS).ConclusionGCB DLBCL, younger patients, and high-risk patients, but not DEL patients, may benefit from continuous-infusion DA-EPOCH-R regimen.