J Cancer 2021; 12(7):2059-2064. doi:10.7150/jca.52958

Research Paper

R-split-EPOCH plus high dose methotrexate in untreated diffuse large B cell lymphoma with MYC rearrangement or double expression of MYC and BCL-2

Peng Sun1,2*, Yu Wang1,2*, Cui Chen3*, Hang Yang1,2, Man Nie1,2, Xiao-Qing Sun1,2, Xiao-Hua He1,2, Wen-Qi Jiang1,2✉, Zhi-Ming Li1,2✉

1. Department of Medical Oncology, Sun Yat-Sen University Cancer Center, 651 Dong Feng RD East, Guangzhou, Guangdong Province 510060, P. R. China.
2. State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dong Feng RD East, Guangzhou, Guangdong Province 510060, P. R. China.
3. Department of Oncology, the First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road Ⅱ, Guangzhou, Guangdong Province 510080, P. R. China.
*These authors contributed equally to this work.

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Citation:
Sun P, Wang Y, Chen C, Yang H, Nie M, Sun XQ, He XH, Jiang WQ, Li ZM. R-split-EPOCH plus high dose methotrexate in untreated diffuse large B cell lymphoma with MYC rearrangement or double expression of MYC and BCL-2. J Cancer 2021; 12(7):2059-2064. doi:10.7150/jca.52958. Available from https://www.jcancer.org/v12p2059.htm

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Abstract

Purpose: Diffuse large B cell lymphoma (DLBCL) with MYC rearrangement or double expression of MYC and BCL-2 (DE DLBCL) has a relatively poor prognosis and does not respond well to standard R-CHOP. In the current study, we aimed to investigate the efficacy and safety of R-split-EPOCH plus high dose methotrexate (HD-MTX) in the particular patient population.

Methods: A total of 28 patients diagnosed with DE DLBCL or DLBCL with MYC rearrangement between January 2015 and December 2018 were included and retrospectively analyzed. All the participants underwent R-split-EPOCH plus HD-MTX as introduction therapy, with split infusion of etoposide, doxorubicin, and vincristine for 48 hours on D1-2 and D10-11, respectively.

Results: The overall objective response (ORR) rate was 100%, with 24 (85.7%) complete response (CR) and 4 (14.3%) partial response (PR). The CR rate was 76.9% and 93.3% for DLBCL patients with MYC rearrangement and DE DLBCL patients, respectively. The 1- and 3-year PFS rate was 100% and 74.9%, respectively. The 1- and 3-year OS rate was 100% and 92.9%, respectively. Grade 3/4 non-hematological toxicity and grade 3/4 hematological toxicity occurred in 50% and 85.7% of patients, respectively. No treatment-related death was reported.

Conclusions: R-split-EPOCH plus HD-MTX regimen is an effective and feasible treatment option for DE DLBCL and DLBCL with MYC rearrangement.

Keywords: R-split-EPOCH, high dose methotrexate (HD-MTX), diffuse large B cell lymphoma (DLBCL), MYC, double expression