R-DA-EPOCH Versus DA-EPOCH-R: Impact of Chemoimmunotherapy Sequencing on Treatment Outcomes in Patients With Diffuse Large B-Cell Lymphoma.

[BACKGROUND] Chemoimmunotherapy with rituximab (R) added to dose-adjusted (DA)-EPOCH (continuous infusion of etoposide, vincristine, and doxorubicin with cyclophosphamide and prednisone) has become a standard treatment approach for high-risk diffuse large B-cell lymphoma (DLBCL) patients. In contrast to pivotal trials that sequenced rituximab with the initiation of each chemoimmunotherapy cycle, our institution adopted delaying rituximab following discharge after EPOCH completion in patients requiring inpatient chemotherapy (DA-EPOCH-R). Herein, we evaluate the efficacy and safety of rituximab sequencing with EPOCH initiation and after EPOCH administration.

[PATIENTS AND METHODS] A retrospective chart review of all DLBCL patients who received first-line treatment with R-DA-EPOCH or DA-EPOCH-R between 2016 and 2023 was conducted. Outcomes of interest included progression-free survival (PFS), overall response rate (ORR), complete response (CR), overall survival (OS), and cumulative incidence of relapse.

[RESULTS] A total of 31 DA-EPOCH-R and 35 R-DA-EPOCH patients were included. PFS at 4-years was not significantly different between DA-EPOCH-R and R-DA-EPOCH treated patients (75.2% vs. 77.9%; HR 1.10; 95% CI, 0.38-3.13; P = .86). ORR (93.5% vs. 100%; P = .22) and CR (90.3% vs. 85.7%; P = .71) were also similar between cohorts. Rituximab-related infusion reactions were higher among R-DA-EPOCH-treated patients with cycle 1 (P = .038).

[CONCLUSION] Our findings suggest delaying rituximab following EPOCH did not affect treatment outcomes and are associated with lower infusion reactions.