R-CHOEP14 in younger high-risk patients with large B cell lymphoma: an effective front-line regimen with cardiac toxicit
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ORIGINAL ARTICLE
R-CHOEP14 in younger high-risk patients with large B cell lymphoma: an effective front-line regimen with cardiac toxicity: a real-life, single-center experience Sandra Bašić-Kinda 1 & Ivo Radman 1 & Dino Dujmović 1 & Ivana Ilić 2 & Marko Kralik 3 & Margareta Dobrenić 4,5 & Lea Galunić-Bilić 6 & Pavle Rončević 1 & Marijo Vodanović 1 & Zrinka Sertić 4 & Ida Hude 1 & Igor Aurer 1,4 Received: 25 June 2020 / Accepted: 17 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Currently, there is no consensus regarding optimal front-line treatment for younger high-risk patients with large B cell lymphoma. American recommendations list only R-CHOP as standard, while European also include R-ACVBP and R-CHOEP14. We have been routinely using the latter regimen at our institution since 2011 and performed this retrospective real-life single-center study to analyze outcomes. Between September 2011 and April 2019, 66 newly diagnosed patients aged 18 to 60 years with B-large cell lymphoma and high-risk age-adjusted International Prognostic Index score were scheduled to receive 6 or 8 cycles of biweekly chemoimmunotherapy with cyclophosphamide, doxorubicin, vincristine, etoposide, steroids, and rituximab (RCHOEP14). After a median follow-up of 4.7 years, the estimated 3-year progression-free survival was 87% (95% CI 80– 96%) and 3-year overall survival 90% (95% CI 83–98%). Grade ≥ 3 hematological side effects occurred in 83% and infectious in 41% of patients; one patient died of toxicity. Grade ≥ 2 cardiac toxicity occurred in 21% of patients, more frequently than previously reported. The cumulative 5-year risk of congestive heart failure with all-cause mortality as the competing risk was 17%. R-CHOEP14 is a very effective and manageable regimen for younger high-risk patients with B-large cell lymphoma, but the risk of cardiotoxicity warrants further investigations. Keywords Lymphoma, Large B cell, Diffuse . Etoposide . Rituximab . Chemotherapy . R-CHOEP
Introduction B-large cell lymphoma (B-LCL) is the most common type of non-Hodgkin lymphoma (NHL) and affecting all age groups. * Igor Aurer [email protected]; [email protected] 1
Division of Hematology, Department of Internal Medicine, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia
2
Department of Pathology and Cytology, University Hospital Centre Zagreb, Zagreb, Croatia
3
Department of Radiology, University Hospital Centre Zagreb, Zagreb, Croatia
4
Medical School, University of Zagreb, Zagreb, Croatia
5
Department of Nuclear Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
6
Department of Oncology, University Hospital Centre Zagreb, Zagreb, Croatia
R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and steroids) is the most frequently used front-line regimen for this disease. However, less than 60% of younger high-risk patients, commonly defined as those with ageadjusted international prognostic index (aaIPI) 2-3, are cured with this regimen [1, 2]. Front-line trea
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