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Reduced-dose EPOCH-R chemotherapy for elderly patients with advanced stage diffuse large B cell lymphoma

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Abstract

The standard treatment in elderly patients with diffuse large B cell lymphoma (DLBCL) has not yet been finely established. We investigated the efficacy and safety of rituximab with a reduced-dose of EPOCH chemotherapy in elderly patients who had advanced DLBCL with high IPI scores. The dose of 70% EPOCH was given to patients aged 75 to 79 years, and dose of 50% to patients aged over 80 years. Thirty-one patients with a median age of 79 years (range 75–86 years) were enrolled. Patients received a median of 6 cycle’s chemotherapy. The complete response rate was 71.0%. The 3-year overall survival (OS) and progression-free survival rates were 62.8 and 60.3%, respectively. The most frequent grade 3/4 adverse effects were neutropenia (3 patients, 7 events), febrile neutropenia (3 patients, 5 events), and pulmonary infection (3 patients, 3 events). Our study showed that ECOG score 3–4, bulky disease, β2-MG > 5.0 mg/L, and loss of any IADL are prognostic factors for OS in univariate analysis. In summary, reduced-dose EPOCH-R chemotherapy for very elderly patients is very effective with acceptable toxicities. Our preliminary study may provide an alternative approach to manage very elderly fit patients with advanced and poor risk DLBCL by first-line treatment with reduced-dose EPOCH-R.

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Acknowledgements

The authors thank Mr. Hong-Fei Gu and his team for their contribution to patient education.

Funding

This research was supported by the Clinical Research Unit of Xin Hua Hospital; the Shanghai Municipal Education Commission-Gaofeng Clinical Medicine Grant (20152219 to R Tao); the Shanghai Municipal Education Commission Research and Innovation Grant (13ZZ084 to R Tao).

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Author notes

  1. WH Zhang, GY Li, and YJ Ma have contributed equally to this paper and should be considered as joint first authors.

Authors and Affiliations

  1. Department of Hematology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China

    Wen-Hao Zhang, Gao-Yang Li, Yu-Jie Ma, Zhi-Chao Li, Yang Zhu, Jun Chang, Si-Guo Hao & Rong Tao

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  1. Wen-Hao Zhang
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  2. Gao-Yang Li
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Correspondence to Rong Tao.

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The dose-reduced EPOCH-R protocol was reviewed and approved by the hospital ethics committee. All the patients were fully informed of the adverse drug reactions and they signed an informed consent in accordance with the Declaration of Helsinki.

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The authors declare that they have no conflict of interest.

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Zhang, WH., Li, GY., Ma, YJ. et al. Reduced-dose EPOCH-R chemotherapy for elderly patients with advanced stage diffuse large B cell lymphoma. Ann Hematol 97, 1809–1816 (2018). https://doi.org/10.1007/s00277-018-3369-7

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