# NCI dose-adjusted EPOCH-R in Burkitt and MYC-rearranged large B-cell lymphoma

Source: https://onco.cc/trials/nci-da-epoch-r-myc-burkitt/  
OnCo record `nci-da-epoch-r-myc-burkitt` (Trial). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A single-arm study gave an intensive infusional chemotherapy to people with aggressive B-cell lymphoma carrying a MYC rearrangement, including double-hit disease, and about seven in ten were alive and free of events four years later.

## Summary

Retrospective series had suggested that aggressive B-cell lymphomas with a MYC rearrangement, alone or with a BCL2 or BCL6 rearrangement, do worse with R-CHOP than without one. This NCI-sponsored phase 2 study gave dose-adjusted EPOCH-R (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin and rituximab), with CNS prophylaxis, for six cycles. The registry lists Burkitt lymphoma, MYC-positive diffuse large B-cell lymphoma and plasmablastic lymphoma among its conditions and 194 participants in total.

The final analysis of the MYC-rearranged large B-cell cohort (Lancet Haematology 2018) covers 53 patients, median age 61, 81 per cent with stage III or IV disease; 19 had a MYC rearrangement alone and 24 also had a BCL2 or BCL6 rearrangement, or both. After a median follow-up of 55.6 months, 48-month event-free survival was 71.0 per cent and overall survival 76.7 per cent. Grade 4 neutropenia occurred in 53 per cent of cycles and there were three treatment-related deaths, all from infection. The authors concluded the regimen should be considered for these diseases.

It is single-arm. The randomised CALGB 50303 found no advantage for the same regimen over R-CHOP in unselected diffuse large B-cell lymphoma, and no randomised trial has been confined to MYC-rearranged or double-hit disease.

## Fields

- Kind: Trial
- Status: positive
- Last checked: 2026-11-03
- Also known as: DA-EPOCH-R in MYC-rearranged lymphoma; Dunleavy 2018
- Tags: lymphoma-evidence-entities
- Registry id: NCT01092182
- Phase: 2
- Setting: Untreated Burkitt lymphoma, MYC-rearranged diffuse large B-cell lymphoma and plasmablastic lymphoma: dose-adjusted EPOCH-R with CNS prophylaxis
- Sponsor: National Cancer Institute (NCI)
- Enrolled: 194
- Result: In 53 patients with MYC-rearranged aggressive B-cell lymphoma, 48-month event-free survival 71.0 per cent and overall survival 76.7 per cent.
- Outcomes: Event-free survival at 48 months: DA-EPOCH-R, MYC-rearranged cohort 71%; Overall survival at 48 months: DA-EPOCH-R, MYC-rearranged cohort 76.7%
- Replication: Single arm. The randomised CALGB 50303 found no benefit for the same regimen in unselected diffuse large B-cell lymphoma.

## Sources

- ClinicalTrials.gov NCT01092182: https://clinicaltrials.gov/study/NCT01092182
- Lancet Haematology 2018: https://doi.org/10.1016/S2352-3026(18)30177-7

## Connected records

- cancers: [Burkitt lymphoma](https://onco.cc/cancers/burkitt-lymphoma/), [Diffuse large B-cell lymphoma](https://onco.cc/cancers/dlbcl/), [High-grade B-cell lymphoma with MYC and BCL2 rearrangements (double-hit lymphoma)](https://onco.cc/cancers/high-grade-b-cell-lymphoma-myc-bcl2/), [Non-Hodgkin lymphoma (all types)](https://onco.cc/cancers/non-hodgkin-lymphoma/), [Plasmablastic lymphoma](https://onco.cc/cancers/plasmablastic-lymphoma/)
- fronts: [Chemotherapy](https://onco.cc/fronts/chemotherapy/)
- technologies: [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/)
- targets: [BCL-2](https://onco.cc/targets/bcl2/), [MYC](https://onco.cc/targets/myc-gene/)
- drugs: [Cyclophosphamide](https://onco.cc/drugs/cyclophosphamide/), [Doxorubicin](https://onco.cc/drugs/doxorubicin/), [Etoposide](https://onco.cc/drugs/etoposide/), [Prednisone](https://onco.cc/drugs/prednisone/), [Rituximab](https://onco.cc/drugs/rituximab/), [Vincristine](https://onco.cc/drugs/vincristine/)
- institutions: [National Cancer Institute (NIH)](https://onco.cc/institutions/nci/)
- terms: [CNS prophylaxis in aggressive B-cell lymphoma, and the evidence against it](https://onco.cc/terms/lymphoma-tx-cns-prophylaxis/), [Double-hit / high-grade B-cell lymphoma](https://onco.cc/terms/double-hit-lymphoma/), [The lymphoma regimen alphabet: R-CHOP, pola-R-CHP, DA-EPOCH-R, ABVD, BEACOPP and the rest](https://onco.cc/terms/lymphoma-tx-regimen-alphabet/)
- trials: [Alliance/CALGB 50303](https://onco.cc/trials/calgb-50303/)
- key papers: [Dose-adjusted EPOCH-R (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab) in untreated aggressive diffuse large B-cell lymphoma with MYC rearrangement: a prospective, multicentre, single-arm phase 2 study](https://onco.cc/key-papers/paper-da-epoch-r-myc-rearranged-lymphoma-lancet-haematol-2018/)

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