Dose-Adjusted EPOCH +/- Rituximab in Older Patients with High Grade Diffuse Large B-Cell Lymphoma, Burkitt and T-Cell Lymphoma: An Effective Regimen with Acceptable Toxicity Profile

• Published in: Blood 2014-12, Vol.124 (21), p.4450-4450
• Main Authors: Owens, Colette N, Migliacci, Jocelyn C, Horwitz, Steven M., Matasar, Matthew J, Moskowitz, Alison J, Noy, Ariela, Palomba, Maria Lia, Portlock, Carol S., Straus, David J., Younes, Anas, Zelenetz, Andrew D., Hamlin, Paul A.
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood.V124.21.4450.4450

Background: NHL is a disease of older adults and henceforth the oncology community will be increasingly confronted with the challenges of the older lymphoma patient (pt). Phase II data demonstrates dose-adjusted (DA)-EPOCH +/- rituximab is efficacious in high grade and aggressive NHL (J Clin Oncol. 2008 Jun 1;26(16): 2717-24). Additionally, infusional doxorubicin may confer greater safety in elderly pts compared with bolus delivery. A Phase III trial (NCT00118209) comparing DA-R-EPOCH and R-CHOP has been completed, but the results are not currently available. To date, there is limited data on efficacy and safety in elderly patients treated with DA-R-EPOCH. We explored our single center experience to inform therapeutic choices in older adults. Methods: We retrospectively reviewed all pts treated with EPOCH at MSKCC from 2003 to 2014, identifying 181 pts in total, of which 54 pts > 60 yrs (out of 73 pts >60 yr) received DA-EPOCH at initial diagnosis. Data was available regarding their baseline characteristics, dose adjustments/treatment modifications, hospitalizations, and disease related outcomes for all pts. Outcome measures included progression free (PFS) and overall survival (OS), hospitalizations, and dose adjustments. Results: Of 54 patients, histologies included DLBCL (n=42, 78%), T-cell lymphoma (n=8, 15%), and Burkitt lymphoma (BL) (n=4, 7%). The median age of all patients was 70.5 yrs (range 61-93 yrs), with 54% female. Prior malignancy was present in 31% and baseline LVEF was >55% in 98% of pts. For DLBCL patients (n=42): median age 72 yrs (61-92 yr), M:F 24:18, Stage I/II v. III/IV: 21% v. 79%, aaIPI 0-1 v. 2-3: 24% v 76%; cell of origin (Hans) GC/ABC/unknown: 43%/52%/5%. Ki67%: median 90% (range 20-100%). T-cell pts (n=8): median age 68 yrs (61-75 yr), female 50%, histology ATLL(n=4), PTCL (n=3), ALCL ALK- (n=1); 100% adv. stage; BL pts (n=4): ages 65, 69, 82, 81 yrs, 1 early stage, 3 adv. stage, 1 low risk, 3 high risk. Rituximab was given in 96% of b-cell NHL. Peg-GCSF/GCSF was used with each cycle of EPOCH. A full 6 cycles of EPOCH was completed 52% of the time and dose adjusted in 66% of pts with a median of 4 adjusted cycles/pt (range 1-6). Dose increases occurred in 30% of pts, dose decreases 26%; 11% of pts started at dose level -1. Safety: Cardiac events occurred in 22% of pts, with 2 pts experiencing anthracycline induced cardiomyopathy/CHF, the remainder included G ≥3 arrhythmias (n=6) or chest pain/angina (n=4) without change in EF. H