{"entity":{"id":"paper-da-epoch-r-myc-rearranged-lymphoma-lancet-haematol-2018","kind":"paper","name":"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","aka":["Dunleavy 2018"],"tldr":"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.","asOf":"2026-11-03","links":[{"label":"Lancet Haematology 2018","url":"https://doi.org/10.1016/S2352-3026(18)30177-7"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/30501868/"},{"label":"Europe PMC","url":"https://europepmc.org/article/MED/30501868"}],"tags":["lymphoma-evidence-entities"],"related":[],"cancers":["high-grade-b-cell-lymphoma-myc-bcl2","dlbcl"],"sections":[],"technologies":[],"targets":["myc-gene","bcl2"],"drugs":["rituximab","etoposide","prednisone","vincristine","cyclophosphamide","doxorubicin"],"companies":[],"institutions":[],"pathways":[],"terms":["double-hit-lymphoma"],"trials":["nci-da-epoch-r-myc-burkitt","calgb-50303"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"journal":"Lancet Haematology","year":2018,"doi":"10.1016/S2352-3026(18)30177-7","pmid":"30501868","authors":"Dunleavy K, Fanale MA, Abramson JS, et al.","paperType":"observational","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."],"whatItMeans":"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."],"participants":53},"route":"/key-papers/paper-da-epoch-r-myc-rearranged-lymphoma-lancet-haematol-2018/","neighbours":{"cancer":[{"id":"dlbcl","kind":"cancer","name":"Diffuse large B-cell lymphoma","route":"/cancers/dlbcl/"},{"id":"high-grade-b-cell-lymphoma-myc-bcl2","kind":"cancer","name":"High-grade B-cell lymphoma with MYC and BCL2 rearrangements (double-hit lymphoma)","route":"/cancers/high-grade-b-cell-lymphoma-myc-bcl2/"}],"target":[{"id":"bcl2","kind":"target","name":"BCL-2","route":"/targets/bcl2/"},{"id":"myc-gene","kind":"target","name":"MYC","route":"/targets/myc-gene/"}],"drug":[{"id":"cyclophosphamide","kind":"drug","name":"Cyclophosphamide","route":"/drugs/cyclophosphamide/"},{"id":"doxorubicin","kind":"drug","name":"Doxorubicin","route":"/drugs/doxorubicin/"},{"id":"etoposide","kind":"drug","name":"Etoposide","route":"/drugs/etoposide/"},{"id":"prednisone","kind":"drug","name":"Prednisone","route":"/drugs/prednisone/"},{"id":"rituximab","kind":"drug","name":"Rituximab","route":"/drugs/rituximab/"},{"id":"vincristine","kind":"drug","name":"Vincristine","route":"/drugs/vincristine/"}],"term":[{"id":"double-hit-lymphoma","kind":"term","name":"Double-hit / high-grade B-cell lymphoma","route":"/terms/double-hit-lymphoma/"}],"trial":[{"id":"calgb-50303","kind":"trial","name":"Alliance/CALGB 50303","route":"/trials/calgb-50303/"},{"id":"nci-da-epoch-r-myc-burkitt","kind":"trial","name":"NCI dose-adjusted EPOCH-R in Burkitt and MYC-rearranged large B-cell lymphoma","route":"/trials/nci-da-epoch-r-myc-burkitt/"}]}}