# 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

Source: https://onco.cc/key-papers/paper-da-epoch-r-myc-rearranged-lymphoma-lancet-haematol-2018/  
OnCo record `paper-da-epoch-r-myc-rearranged-lymphoma-lancet-haematol-2018` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

In a single-arm study of 53 people with MYC-rearranged aggressive B-cell lymphoma, including double-hit disease, intensive infusional chemotherapy left 71 per cent alive and free of events at four years.

## Summary

The final analysis of a prospective multicentre single-arm phase 2 study (NCT01092182) of dose-adjusted EPOCH-R, given with CNS prophylaxis for six cycles, in untreated aggressive B-cell lymphoma with MYC rearrangement. Primary endpoints included event-free and overall survival. The background the authors give: MYC rearrangement is present in about 10 per cent of aggressive B-cell lymphomas, half of which also carry a BCL2 rearrangement.

## Fields

- Kind: Key paper
- Last checked: 2026-11-03
- Also known as: Dunleavy 2018
- Tags: lymphoma-evidence-entities
- Journal: Lancet Haematology
- Year: 2018
- DOI: 10.1016/S2352-3026(18)30177-7
- Authors: Dunleavy K, Fanale MA, Abramson JS, et al.
- Findings: 53 patients, median age 61; 43 (81 per cent) had stage III or IV disease and 26 (49 per cent) a high-intermediate or high IPI.; 19 had a MYC rearrangement alone and 24 also a rearrangement of BCL2, BCL6 or both.; At a median follow-up of 55.6 months, 48-month event-free survival was 71.0 per cent (95 per cent confidence interval 56.5 to 81.4) and overall survival 76.7 per cent (62.6 to 86.1).; Grade 4 neutropenia occurred in 160 of 301 cycles (53 per cent) and fever with neutropenia in 56 (19 per cent); there were three treatment-related deaths, all from infection.
- What it means: Prospective, single-arm evidence for treating MYC-rearranged and double-hit large B-cell lymphoma more intensively than with R-CHOP. It has no control arm, which the entity page says plainly: there has never been a randomised trial confined to this group.
- Caveats: Single arm, 53 patients; the comparison with R-CHOP is with retrospective series.; Sponsored by the NCI, where the regimen was developed.; The randomised CALGB 50303 found no advantage for the same regimen in unselected diffuse large B-cell lymphoma.

## Sources

- Lancet Haematology 2018: https://doi.org/10.1016/S2352-3026(18)30177-7
- PubMed: https://pubmed.ncbi.nlm.nih.gov/30501868/
- Europe PMC: https://europepmc.org/article/MED/30501868

## Connected records

- cancers: [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/)
- 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/)
- terms: [Double-hit / high-grade B-cell lymphoma](https://onco.cc/terms/double-hit-lymphoma/)
- trials: [Alliance/CALGB 50303](https://onco.cc/trials/calgb-50303/), [NCI dose-adjusted EPOCH-R in Burkitt and MYC-rearranged large B-cell lymphoma](https://onco.cc/trials/nci-da-epoch-r-myc-burkitt/)

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