R-CHOP Versus R-EPOCH: No Difference in Survival for Patients With MYC-Rearranged, Double- or Triple-Hit DLBCL

Overall survival (OS) outcomes were similar between patients with MYC-rearranged diffuse large B-cell lymphoma (DLBCL) and double-hit lymphoma (DHL)/triple-hit lymphoma (THL) who were treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone) versus R-EPOCH (rituximab, etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin). These findings were presented at EHA2021 Virtual by Tylan Magnusson, MD, of the University of Alabama at Birmingham.

The investigators analyzed de-identified data from a nationwide Flatiron Health electronic health record database on patients diagnosed with DLBCL at 280 cancer clinics in the U.S. between January 1, 2011, and June 30, 2020. A total of 443 patients with MYC-rearranged DLBCL were selected from the database. Of these, 218 patients had advanced-stage disease, 64 patients had MYC-rearranged DLBCL only, and 117 and 37 had DHL or THL, respectively. Among the group with DHL/THL, 43 patients (median age = 70 years) were treated with R-CHOP and 111 patients (median age = 61 years) received R-EPOCH.
No difference was found in four-year OS rates between the R-CHOP and R-EPOCH treatment arms in different patient groups:

  • MYC-rearranged DLBCL: 32.8% with R-CHOP vs. 30.4% with R-EPOCH
  • DHL/THL: 54.5% with R-CHOP vs. 49.6% with R-EPOCH

For patients with DHL/THL, 89% of deaths occurred within two years of diagnosis, while for patients with MYC-rearranged DLBCL, 78% of deaths occurred in the first two years. Patients with only MYC-rearranged DLBCL tended to have worse OS, but this finding may be attributed to this group’s small sample size.

A multivariable analysis found that Eastern Cooperative Oncology Group Performance Status score of ≥2 (p<0.001) and elevated lactate dehydrogenase levels (p=0.041) were independently associated with worse mortality for these patients. “Further studies are needed for better risk stratification of patients with DLBCL for optimizing outcomes,” Dr. Magnusson said.

Study authors report no relevant conflicts of interest.

Reference

Magnusson T, Narkhede M, Mehta A, et al. No difference in overall survival between R-CHOP and R-EPOCH among patients with advanced stage MYC-rearranged, double hit, or triple hit diffuse large B-cell lymphoma. Abstract #S224. Presented at the EHA2021 Virtual Congress, June 9-17, 2021.