Loading
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.
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.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
194 enrolled.
95 per cent confidence interval 56.5 to 81.4
Source95 per cent confidence interval 62.6 to 86.1
Source| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Event-free survival at 48 monthsprimary | DA-EPOCH-R, MYC-rearranged cohort | 53 | 71% | - | - | link |
| Overall survival at 48 monthsprimary | DA-EPOCH-R, MYC-rearranged cohort | 53 | 76.7% | - | - | link |
Shares Prednisone, Vincristine, Etoposide, Doxorubicin and the tag lymphoma-evidence-entities.
Shares Etoposide, Non-Hodgkin lymphoma (all types), Cytotoxic chemotherapy and the tag lymphoma-evidence-entities.
Shares Etoposide, Cytotoxic chemotherapy and the tag lymphoma-evidence-entities.
Shares Etoposide and the tag lymphoma-evidence-entities.
Shares Double-hit / high-grade B-cell lymphoma, Alliance/CALGB 50303, The lymphoma regimen alphabet: R-CHOP, pola-R-CHP, DA-EPOCH-R, ABVD, BEACOPP and the rest, Prednisone.
Shares Prednisone, Vincristine, Rituximab, Doxorubicin.
Shares Prednisone, Vincristine, Rituximab, Doxorubicin.
Shares Prednisone, Vincristine, Rituximab, Doxorubicin.
Every source this page cites, grouped by who published it. Grouping is read from the web address, not assigned by hand.
A source that has moved or gone is reported by the weekly link check. /audit/