DA-EPOCH-R
Checked 2026-09-09
Primary mediastinal B-cell lymphoma, high-grade B-cell lymphoma with MYC and BCL2 rearrangements, Burkitt lymphoma in adults, and HIV-associated lymphomas
Also called EPOCH, R-EPOCH, dose-adjusted EPOCH-R.
One cycle
every 21 days × 6 · about 18 weeks in totalComponents
| Drug | Dose | Route | Days | Note |
|---|---|---|---|---|
Rituximab Monoclonal antibody (anti-CD20, chimeric) | 375 mg/m² | IV | D1 | |
Etoposide Topoisomerase II inhibitor (podophyllotoxin derivative) | 50 mg/m² per day | IV | D1-4 (96 h infusion) | |
Doxorubicin Cytotoxic chemotherapy (anthracycline) | 10 mg/m² per day | IV | D1-4 (96 h infusion) | |
Vincristine Vinca alkaloid (microtubule inhibitor) | 0.4 mg/m² per day | IV | D1-4 (96 h infusion) | |
Cyclophosphamide Alkylating agent (oxazaphosphorine prodrug) | 750 mg/m² (dose adjusted to the previous cycle's nadir) | IV | D5 | |
Prednisone Glucocorticoid | 60 mg/m² twice daily | Oral | D1-5 |
Cycles
6
21-day cycle
Emetogenicity
High (>90%)
G-CSF
Built into the protocol
Notes
- Doses of etoposide, doxorubicin and cyclophosphamide are escalated or reduced each cycle according to the neutrophil nadir.
- Continuous infusion needs a central line; G-CSF from day 6.
Used in
Source
Dunleavy, NEJM 2013: DA-EPOCH-R in primary mediastinal B-cell lymphoma
Reference doses for a typical adult from the cited protocol or label. Doses are adjusted for renal and hepatic function, age, performance status and prior toxicity, and institutional protocols vary. Verify against the current label and your local protocol before treating. Not medical advice.
Other regimens for these cancers
R-CHOP
Diffuse large B-cell lymphoma, first line (6 cycles; 3-4 with radiotherapy for limited stage)
every 21 days × 6
Pola-R-CHP
Untreated DLBCL, IPI 2-5
every 21 days × 6
R-ICE
Relapsed or refractory DLBCL, salvage before autologous transplant (late relapse) or bridging
every 14 days × 2-3
Fludarabine + cyclophosphamide lymphodepletion, then CD19 CAR-T
Relapsed or refractory large B-cell lymphoma (second line if refractory or relapse within 12 months), B-ALL, follicular and mantle cell lymphoma
every 6 days
CHOP
Peripheral T-cell lymphomas first line (often with etoposide as CHOEP, or brentuximab replacing vincristine for CD30-positive disease); the historical backbone of R-CHOP in B-cell lymphoma
every 21 days × 6
ICE
Relapsed or refractory aggressive lymphoma and Hodgkin lymphoma, salvage and stem cell mobilisation before autologous transplant (R-ICE when rituximab is added)
every 14 days × 2-3
Hyper-CVAD
Adult acute lymphoblastic leukaemia (with a tyrosine kinase inhibitor if Philadelphia-positive), Burkitt lymphoma and younger patients with mantle cell lymphoma
every 21 days × 8