Safety and Efficacy of R-CEEP (Rituximab, Cyclophosphamide, Epirubicin, Etoposide, Prednisolone) in Elderly or Unfit Patients with Diffuse Large B-Cell Lymphoma (DLBCL): A Retrospective Single-Centre Experience

• Published in: Blood 2019-11, Vol.134 (Supplement_1), p.2911-2911
• Main Authors: Yeung, James, Campbell, Ashlea, Bryant, Christian E, Khoo, Liane, Dunkley, Scott, Iland, Harry J, Larsen, Stephen R, Moreton, Susan, Joshua, Douglas E, Vanguru, Vinay, McCulloch, Derek A, Hsu, Danny, Gibson, John, Ho, P. Joy, Brown, Christina
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2019-131589

Background DLBCL is the most common subtype of non-Hodgkin lymphoma in elderly patients (age ≥70). R-CHOP is the standard of care for upfront treatment of fit patients, but may not be tolerated in patients with advanced age and/or comorbidities. There is no established standard of care for this group of patients and dose reduction (R-miniCHOP) or avoidance/replacement of anthracyclines are common strategies, aiming to deliver tolerable immunochemotherapy and provide meaningful outcomes and potential cure. R-CEEP is a dose-reduced regimen that incorporates etoposide and an alternate anthracycline epirubicin. We describe our single-centre experience with R-CEEP for elderly (age ≥70) or unfit patients (CIRS-G >6) with newly-diagnosed or relapsed DLBCL deemed unsuitable for R-CHOP. Method All patients receiving R-CEEP for a histological diagnosis of DLBCL at Royal Prince Alfred Hospital from 2000 to 2019 were retrospectively reviewed. R-CEEP (rituximab 375mg/m2 day 1, cyclophosphamide 300mg/m2 day 1, epirubicin 50mg/m2 day 1, etoposide 100mg/m2 day 1 and prednisolone 50mg daily for days 1-5) was delivered every 14 or 21 days at physician discretion planning for 6 cycles. GCSF and antimicrobial prophylaxis were used at physician discretion. The cardiac ejection fraction was assessed as satisfactory (>50%) prior to commencement. Baseline demographics, R-IPI, co-morbidities as assessed by CIRS-G, treatment response and adverse events (AEs) were recorded. Results Data from 61 patients were reviewed; 54 received R-CEEP for de novo DLBCL and 7 for DLBCL with a background of previously-treated lymphoma (1 DLBCL; 6 low-grade NHL). The median age at diagnosis was 80 (range 34-93), with 79% aged 75 and 28% aged 85. Thirty-three patients (54%) were female; 87% had Ann Arbor stage III/IV and 52% had R-IPI 3-5. Median CIRS-G was 9 (range 2-20) with 74% of patients having CIRS-G >6. GCSF prophylaxis was used in 67%. The median follow-up was 2.7 years (range 0.1-10.0 years). Overall response was 54/61 (89%), with complete response (CR) in 42 (69%), partial response (PR) in 12 (20%) and progressive disease (PD) in 1 (2%). Response was not assessed in 6 patients due to early treatment discontinuation for palliation or AEs (4), cerebral palsy (1) and loss to follow-up (1). In patients receiving R-CEEP as upfront therapy, CR was obtained in 38/54 (70%), PR in 10/54 (19%) and 6 were not assessed as above. In the 7 patients receiving R-CEEP as salvage therapy, 4 obtained CR, 2 PR