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Objectives: We recently performed a single‐arm phase II trial of DA‐EPOCH in adults with acute lymphoblastic leukemia (ALL). We sought to compare these results to those with standard Hyper‐CVAD. Methods: We created a retrospective matched cohort of patients who received Hyper‐CVAD (n = 69) at our center and otherwise met eligibility criteria for the DA‐EPOCH trial (n = 53). Results: Our outcomes support the use of Hyper‐CVAD over DA‐EPOCH in Ph− disease for both overall survival (OS; HR 0.18, p =.004) and event‐free survival (EFS; HR 0.51, p =.06). In contrast, outcomes were similar in Ph+ disease (OS HR 0.97, p =.96; EFS HR 0.65, p =.21). Rates of morphologic remission and measurable residual‐disease negativity were similar between the regimens. Hyper‐CVAD was associated with significantly more febrile neutropenia (OR 1.9, p =.03) and a greater incidence of Grade 4 or 5 adverse events (20% vs. 6%). Average transfusions per cycle of both red blood cells (p <.001) and platelets (p <.001) were five‐fold higher with Hyper‐CVAD. Conclusions: Our findings support continued use of Hyper‐CVAD for Ph− ALL but suggest that DA‐EPOCH may be a reasonable alternative for Ph+ ALL. These data also highlight a potential role for DA‐EPOCH in resource‐limited settings or when more intense therapy is not feasible. [ABSTRACT FROM AUTHOR]

Purpose: Dose‐adjusted EPOCH and rituximab (DA‐EPOCH‐R) is a regimen used for the treatment of high‐risk diffuse large B‐cell lymphoma (DLBCL) designed to overcome resistance to standard R‐CHOP by combining prolonged exposure of lymphoma cells to cytotoxic agents and dose‐adjustment based on toxicity. Data on outcomes of older patients are scarce. Patients and Methods: We collected data on patients with newly diagnosed high‐risk DLBCL older than 60 years treated with DA‐EPOCH‐R. High‐risk patients were defined by the age‐adjusted international prognostic index score 2 or 3. Results: A total of 120 patients were included. Median age was 69 years (range 60–82). Response rate was 74%; with 59% complete responses. Dose of DA‐EPOCH‐R was escalated in 50 patients (42%). Three‐year progression‐free survival (PFS) and overall survival (OS) was 53% and 58%, respectively, with treatment‐related mortality (TRM) of 13%. In univariate analysis, favorable prognostic factors were performance status (PS) (0–2 vs. 3–4), age (<70 vs. ≥70 years), and center. In multivariate analysis, PS and center retained prognostic significance. Patients with PS 0–2 had 3‐year PFS and OS of 58% and 64%, respectively, with TRM of 6%. Conclusion: DA‐EPOCH‐R is efficacious in sufficiently fit older high‐risk DLBCL patients. Patients with poor PS have unacceptable toxicity and require less intensive therapy. [ABSTRACT FROM AUTHOR]

CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) −/+ rituximab (R) is the standard chemotherapeutic regimen for aggressive lymphoma, but is insufficient for aggressive lymphoma with adverse prognostic factors. Dose-adjusted (DA)-EPOCH (etoposide, doxorubicin, cyclophosphamide, vincristine, and prednisolone) −/+ R demonstrates excellent efficacy against some aggressive lymphoma. Thus, we conducted a retrospective study to evaluate the feasibility and efficacy of this therapy in clinical practice. We enrolled 149 patients from 17 institutions diagnosed between 2007 and 2015. The median follow-up period for survivors was 27 months (range 0.2–123). The complete response (CR) rate of newly diagnosed patients was 79% (95% CI 68–87%). All patients were hospitalized to receive this therapy and 94% of patients also received granulocyte-colony-stimulating factor support. There were no treatment-related deaths. Febrile neutropenia (FN) and grade 3 or 4 infection occurred in 55% and 28% of patients, respectively. There were no significant differences in FN or infection between young (≤ 65 years) and elderly patients (> 65 years). In newly diagnosed diffuse large B-cell lymphoma-not otherwise specified patients (n = 46), the CR rate was 80% (95% CI 64–91%) and the 2-year OS rate was 81% (95% CI 66–90%). In the present study, DA-EPOCH −/+ R exhibited excellent efficacy and feasibility for aggressive lymphoma. [ABSTRACT FROM AUTHOR]

Abstract The unique biological features of primary mediastinal large B-cell lymphoma are offering suggestions for the development and application of innovative drugs in patients who do not respond to first-line regimens or relapse. This lymphoma, in fact, is characterised by high rates of curability with standard anthracycline-containing chemoimmunotherapy regimens, but still displays a severe prognosis if adequate responses are not rapidly achieved or if the disease recurs. Radiotherapy has proved to be effective to consolidate responses after induction, but it may be safely avoided in certain cases, especially when a metabolic complete response is obtained, as to reduce the incidence of radiation-induced long-term sequelae. The current management of this lymphoma, both at diagnosis and at relapse, is reviewed in this paper, along with the description of its peculiar biological panorama. [ABSTRACT FROM AUTHOR]