A dose-adjusted regimen of etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (EPOCH-R) appears to produce durable remission in patients with MYC-rearranged aggressive B-cell lymphomas, according to a study published in The Lancet Haematology.

Researchers conducted a prospective, multicenter, single arm, phase 2 study of dose-adjusted EPOCH-R in 53 patients (median age, 61 years) with previously untreated MYC-rearranged aggressive B-cell lymphoma, 43 of whom had stage 3 or 4 disease. Almost half (49%) had high-intermediate or high international prognostic index (IPI) scores. Among the 53 patients, 39 achieved a complete response and 7 achieved a partial response. The overall response rate was 87%.

After a median follow-up of 55.6 months, 48-month event-free survival was 71.0% and overall survival was 76.7%. Grade 4 neutropenia occurred in 53% of the 301 treatment cycles. Other adverse events included thrombocytopenia, fever, and motor neurotoxicity. There were 3 treatment-related deaths due to infection.

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Assessment of patients with double-hit lymphoma by IPI score demonstrated overall survival of 90.9% for patients with low and low-intermediate scores and 72.2% for patients with high and high-intermediate scores (P =.025). An analysis of all patients yielded similar results.

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The authors concluded that most patients, including those with MYC rearrangement alone or with additional rearrangements in BCL2 or BCL6, can achieve durable remission with dose-adjusted EPOCH-R. However, the optimal regimen for patients with aggressive B-cell lymphoma with MYC rearrangement remains undefined. A phase 1 trial (ClinicalTrials.gov Identifier: NCT03036904) is currently under way in an attempt to further improve patient outcomes.


1. Dunleavy K, Fanale MA, Abramson JS, et al. Dose-adjusted EPOCH-R (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab) in untreated aggressive diffuse large B-cell lymphoma with MYC rearrangement: a prospective, multicentre, single-arm phase 2 study [published online December 1, 2018]. Lancet Haematol. doi: 10.1016/S2352-3026(18)30177-7