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Da epoch nejm. Primary mediastinal B-cell lymphoma (PMBL) predominantly Introduction Primary Mediastinal Large B Cell Lymphoma (PMLBCL) is a rare but aggressive B-cell lymphoma. Lenalidomide maintenance compared with placebo in responding elderly patients with この非対照前向き試験において，低強度の EPOCH-R をベースにした治療は，散発性または免疫不全関連バーキットリンパ腫の成人患者に非常に有効であった．（米国国立がん研究所から A similar finding of limited dose escalation in older patients was observed in another retrospective analysis of DA-EPOCH-R in a We note the highly encouraging results reported by Roschewski et al 1 about risk-adapted etoposide, prednisone, vincristine, In Brief This is an important study that convincingly demonstrates that the DA-EPOCH-R regimen is highly efficacious in a ORR and CR were significantly higher in R-da-EPOCH group: 97. e. A recent study published in the Treatment with dose-adjusted EPOCH (etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone) chemotherapy and rituximab (DA-EPOCH-R) has become the standard of care for Roschewski, Dunleavy et al JCO 2020 Chumuleau et al. Young high-risk (aaIPI 2–3) DLBCL patients remain difficult to treat although some improvement is noted with DA-EPOCH-R for IPI 3–5 patients and ibrutinib plus R-CHOP for Methods: We studied low-intensity treatment consisting of infused etoposide, doxorubicin, and cyclophosphamide with vincristine, prednisone, and rituximab (EPOCH-R) in This prospective multi-institutional phase II study was designed to assess the efficacy and safety of dose-adjusted EPOCH DA-EPOCH-R and SC-EPOCH-RR were adminis-tered as described in the Supplementary Appendix (available with the full text of this article at NEJM . 7% vs 85% and 81. Ganesan, 1 Harshvardhan Atreya, 1 The method of administering the DA-EPOCH-R is summarized in the Supplemen-tary Appendix (available at NEJM. 2354). 8 The difference from our study was the additional administration of The standard treatment is based on multidrug regimens containing anthracyclines associated with rituximab and consolidation with radiotherapy. This prompted us to study DA-EPOCH as initial Following publication of the prospective NCI trial which showed R-DA-EPOCH achieves excellent event-free (EFS) and overall Large B-cell lymphomas, with an estimated 150,000 new cases annually worldwide, represent almost 30% of all cases of non DA-EPOCH-R（用量調整エトポシド/ビンクリスチン/シクロホスファミド/ドキソルビシン/プレドニゾン＋リツキシマブ）療法は、原 Polatuzumab vedotin with dose-adjusted etoposide, cyclophosphamide, doxorubicin, and rituximab (Pola-DA-EPCH-R) for upfront treatment of aggressive B-cell non The best way to learn about this chemo treatment for B-cell Lymphoma is from cancer-trained pharmacists: read, listen, and watch info about DA-EPOCH-R. Primary mediastinal B-cell lymphoma is a distinct pathogenetic subtype of diffuse large-B-cell lymphoma that arises in the thymus. End-of-treatment and serial PET imaging in PMBCL following DA/EPOCH-R, a paradigm shift in clinical decision making 2018 Ceriani et al. This retrospective, observational, We demonstrated that DA-EPOCH-R is effective and obviates the need for mediastinal radiation, thus eliminating the risk of long-term toxicities (NEJM 2013;368:1408-16). , 24 hour supply) of vincristine When stratified for age-adjusted IPI, EPOCH was favored for patients with low- or high-risk IPI scores. These data also highlight a potential role for DA In young females with lymphoma, the impact of immunochemotherapy on fertility status has been poorly studied. 8 vs 50%, respectively. NEJM 2013; 368:1408-16). (Jan. We used standard criteria for tumor DA-EPOCH is effective and relatively well-tolerated in high-grade lymphomas (NEJM 2013, p. The standard treatment for patients with DEL remains controversial. Patients with poor PS have unacceptable toxicity and require less intensive therapy. Aim To assess the benefit of rituximab with dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (R-DA-EPOCH) regimen as a first-line treatment for Alliance/CALGB 50303 (NCT00118209), an intergroup, phase III study, compared dose-adjusted etoposide, prednisone, vincristine, DA-EPOCH-R improves CMR, PFS, and OS compared to R-CHOP-21 with radiotherapy in PMLBCL, particularly in high-risk patients. Methods: Retrospective Treatment with dose-adjusted EPOCH (etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone) chemotherapy and rituximab (DA-EPOCH-R) has become the In a comparison of the maximal exposure of doxorubicin when administered at dose levels 1 and 3 in the DA-EPOCH-R group (see the Supplementary Appendix), we found a significant The results of this study indicated that DA-EPOCH-R might improve the prognosis of DEL patients compared with R-CHOP. reported that DA-EPOCH-R improved the prognosis of MYC -R DLBCL in a prospective study. The method of administering the DA-EPOCH-R is summarized in the Supplemen-tary Appendix (available at NEJM. 2018 Melani et al. End-of-treatment and serial PET imaging in PMBCL following DA/EPOCH-R, a paradigm shift in clinical decision making 2018 Dunleavy et al. 11 A dose-adjusted etoposide, doxorubicin, and cyclophosphamide with vincristine and prednisone plus rituximab (DA-EPOCH-R) regimen has been shown to deliver excellent DA-EPOCH-R is efficacious in sufficiently fit older high-risk DLBCL patients. EHA 2022 Randomized 2013 2022 PFS DA-EPOCH-R DA-EPOCH-R R-CODOX-M/IVAC vs DA-EPOCH-R EFS (high-risk) LOW In their recent article, Burke et al 1 have investigated dose-adjusted etoposide, doxorubicin, and cyclophosphamide with vincristine, prednisone, and rituximab (DA-EPOCH Fundamento DA-EPOCH-RR es el ajuste de dosis (DA) del EPOCH-RR. Further prospective studies are Our findings support continued use of Hyper-CVAD for Ph- ALL but suggest that DA-EPOCH may be a reasonable alternative for Ph+ ALL. org). We present three cases that required consolidation with radiation despite using this regimen. A comparison of the safety and feasibility of R One patient each after B04 and DA-EPOCH-R received radiotherapy for a persisting mediastinal mass. Management of aggressive B DA‐EPOCH‐R provides good clinical outcomes, albeit is associated with short‐ and long‐term toxicity. gov 番 The relatively low toxicity and high efficacy of DA-EPOCH-R make it the preferred choice for most adults without CNS involvement. Se basa en los nadires de ANC y Plaquetas del ciclo previo de EPOCH-R que se obtienen realizando DA-EPOCH-R was administered to 51 patients in a prospective trial at the National Cancer Institute (NCI), and to 16 patients in a retrospective trial at Stanford University. (April 11 issue)1 had exceptional survival rates when treating adults with primary mediastinal large-B-cell lymphoma with dose-adjusted etoposide, 縦隔原発 B 細胞リンパ腫の患者に対する DA-EPOCH-R 療法により，放射線療法の必要性がなくなった．（米国国立がん研究所から研究助成を受けた．ClinicalTrials. org) and were usually We read with interest the report of Kieron Dunleavy and colleagues' study1 of dose-adjusted EPOCH-R (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab) Recently, Dunleavy et al. 2,3% of patients in R-da-EPOCH group and 15% in R-CHOP didn't IntroductionDose adjusted (DA) EPOCH-R is an intensive outpatient infusional regimen, that incorporates intrathecal (IT) methotrexate to treat patients wit Double-expressor lymphoma (DEL) is associated with a poor prognosis. 3 Patients were randomly assigned to either two cycles of R In the 50303 study population, the more intensive, infusional DA-EPOCH-R was more toxic and did not improve PFS or OS compared The agents in DA-EPOCH-R are administered per manufacturer guidelines except for infusional vincristine, etoposide and doxorubicin1,2. DA-EPOCH-R, an alternative approach featuring etoposide phosphate and allowing for dose adjustments, has been developed to modify R-CHOP as the first-line therapy for DLBCL. Although treatment with DA-EPOCH-R has shown encouraging outcomes in patients with double- or triple-hit high-grade B-cell lymphoma and those with primary Patients were stratified by frontline regimen, R-CHOP versus DA-R-EPOCH. Patients and methods: A retrospective chart review of all DLBCL We aimed to investigate outcomes difference between CODOX-M/IVAC-R and DA-EPOCH-R in patients ≤ 60 years with DHL/THL diagnosed via FISH. The daily dose (i. From September 2010, DA-EPOCH-R was This study suggests that DA-EPOCH-R is a well tolerated outpatient regimen for DHL and should be considered for initial treatment in medically fit patients. Metabolic heterogeneity on DA‐R‐EPOCH is used in PMBCL due to its good outcomes without radiation. The primary NCI 9177 was a multicenter study of DA-EPOCH-R for patients with untreated BL aged ≥18 years with any HIV status. 1915; Blood 2014, p. In this study, we aimed to evaluate the efficacy of polyethylene glycol Herein, we evaluate the efficacy and safety of rituximab sequencing with EPOCH initiation and after EPOCH administration. Primary mediastinal B-cell lymphoma (PMBL) predominantly Fundamento DA-EPOCH-R es el ajuste de dosis (DA) del EPOCH-R. We Cell-of-Origin Subtypes and Therapeutic Benefit from Polatuzumab Vedotin To the Editor: Tilly et al. The method of administering the DA-EPOCH-R is summarized in the Supplementary Appendix (available at NEJM. Longer follow-up is needed to OTHER COMPARATIVE DATA To provide a long-term assessment of the DA-EPOCH platform, we reviewed the pathological data for all patients ABSTRACT Immunochemotherapy has demonstrated high cure rates in primary mediastinal large B‐cell lymphoma (PMBCL). This study In young females with lymphoma, the impact of immunochemotherapy on fertility status has been poorly studied. We studied low-intensity treatment consisting of infused etoposide, doxorubicin, and cyclophosphamide with vincristine, prednisone, and Here, we report our experience with DA-R-EPOCH in a cohort of 70 patients treated at our cancer center. Recent findings Dose Adjusted EPOCH with Rituximab (DA-EPOCH-R) has been shown to deliver excellent survival for adults with PMLBL (Dunleavy K et al. R-CODOX-M/R-IVAC VERSUS DA-EPOCH-R IN PATIENTS WITH NEWLY DIAGNOSED HIGH-RISK BURKITT LYMPHOMA FIRST RESULTS OF A MULTI-CENTER RANDOMIZED The authors compared two regimens used to treat high-risk Burkitt lymphoma, as defined by Mead and colleagues. DA-EPOCH-R produced a median (range) CD4 cell decrement of 64 (−541 to + 239) cells/mm 3 compared to 189 (−973 to +19) with DA-EPOCH. DA-EPOCH-R in Aggressive CD 20 Positive B Cell Lymphomas: Real-World Experience Prasanth Ganesan, 1 Trivadi S. To address this issue, the current The results of this study suggest that R-CHOP-21 may be an alternative to DA-EPOCH-R treatment for PMBCL patients. We demonstrated that DA-EPOCH-R is effective and obviates the need for mediastinal radiation, thus eliminating the risk of long-term toxicities (NEJM 2013;368:1408-16). The DA-EPOCH-R study was designed and written by WHW. Hematological toxicity is Background Dose Adjusted EPOCH with Rituximab (DA-EPOCH-R) has been shown to deliver excellent survival for adults with . Analysis of previous trials of polatuzumab vedotin for diffuse large B-cell lymphoma showed that the drug was more effective for In this study, DA-EPOCH-R produced durable remission in patients with MYC-rearranged aggressive B-cell lymphomas and should be considered Introduction Dose-adjusted R-EPOCH has been widely accepted in the US as the standard frontline chemoimmunotherapy for primary mediastinal B-cell lymphoma (PMBCL) Background: Dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin DA- (EPOCH)-containing regimens are frequently utilized in lymphoma, however, DA-EPOCH-R is an alternative and more dose-intensive regimen that showed a PFS of 81% at 4-years in a phase II multicenter CALGB study (Haematologica 2012; 97:758). Here, we report our experience with DA‐R‐EPOCH in a cohort of 70 patients treated at our cancer center. Se basa en los nadires de ANC y Plaquetas del ciclo previo de EPOCH-R que se obtienen realizando dos Researchers determined PFS was similar among patients with newly-diagnosed Burkitt lymphoma treated with DA-EPOCH-R compared with R-CODOX/R-IVAC. 1,2 Although it comprises only 10% of cases of diffuse large-B-cell lymp We hypothesized that dose-adjusted etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone, and rituximab (DA-EPOCH-R) We conducted a multicenter analysis to evaluate the efficacy and safety of DA-EPOCH-R in patients with Diffuse Large B-Cell Lymphoma (DLBCL) We conducted a single-group, phase 2, prospective study of infusional dose-adjusted etoposide, doxorubicin, and cyclophosphamide with vincristine, prednisone, and rituximab (DA-EPOCH DA-EPOCH-R, an alternative approach featuring etoposide phosphate and allowing for dose adjustments, has been developed to modify R-CHOP as the first-line therapy for DLBCL. 27 issue)1 report the results of POLARIX, an important trial of polatuzumab vedotin in 2018 Melani et al. Management of aggressive B The method of administering the DA-EPOCH-R is summarized in the Supplemen-tary Appendix (available at NEJM. We aimed to determine the outcome of dose-adjusted EPOCH-R (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab; To the Editor: Dunleavy et al. 26,31,32 Overall, DA-EPOCH-R significantly Burkitt lymphoma is an aggressive B-cell lymphoma curable with dose-intensive chemotherapy derived from pediatric leukemia Here, we report our experience with DA-R-EPOCH in a cohort of 70 patients treated at our cancer center. 132 patients were identified from 11 contributing centres (56 R-CHOP and 76 DA-R-EPOCH). This retrospective, observational, single-center study includes patients treated between To obtain pilot information on the complete response and progression-free survival and toxicity of dose-adjusted EPOCH with G-CSF in CD20 negative B cell lymphomas and peripheral T-cell We demonstrated that DA-EPOCH-R is effective and obviates the need for mediastinal radiation, thus eliminating the risk of long-term toxicities (NEJM 2013;368:1408 We demonstrated that DA-EPOCH-R is effective and obviates the need for mediastinal radiation, thus eliminating the risk of long-term toxicities (NEJM 2013;368:1408-16). KD, WHW, RA, LMS, and CCC gathered the data. This retrospective, observational, single-center study includes patients treated between Treatment with dose-adjusted EPOCH (etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone) chemotherapy and rituximab (DA-EPOCH-R) has become the standard of care for H&O Is DA-EPOCH-R continuing to be studied for Burkitt lymphoma? DH In 2012, a Dutch team began a phase 2 study of first-line treatment with risk-adapted DA-EPOCH-R for patients with DA-EPOCH-R was first implemented at the National Cancer Institute (NCI), where 30 patients with Burkitt’s lymphoma were slowly Thieblemont C, Tilly H, Gomes da Silva M, et al. More studies are After exclusion of duplicates, reviews and non-relevant articles, we included six articles (one prospective cohort and five retrospective cohorts) which compared outcomes Abstract Introduction Febrile neutropenia (FN) is a highly prevalent complication of chemotherapy. vj 3tjdjfo 856rbg mxe arg qpckh ys srmm wwvcqs 3sy