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

• DOI: 10.1007/s00277-020-04353-3
• Publication Date: 2020-11-20T16:11:11Z
• Authors: Sandra Bašić-Kinda; Ivo Radman; Dino Dujmović; Ivana Ilić; Marko Kralik; Margareta Dobrenić; Lea Galunić-Bilić; Pavle Rončević; Marijo Vodanović; Zrinka Sertić; Ida Hude; Igor Aurer
• Keywords: Adult; Male; Middle Aged; Progression-Free Survival; 3. Good health; Young Adult; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Doxorubicin; Vincristine; Antineoplastic Combined Chemotherapy Protocols; chemotherapy ; etoposide ; lymphoma, large B cell, diffuse ; R-CHOEP ; rituximab; Humans; Female; Steroids; Lymphoma, Large B-Cell, Diffuse; Rituximab; Cyclophosphamide; Etoposide; Follow-Up Studies; Retrospective Studies

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 bi-weekly chemoimmunotherapy with cyclophosphamide, doxorubicin, vincristine, etoposide, steroids, and rituximab (R-CHOEP14). 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.