Department of Haematology, Sunshine Cost University Hospital, Sunshine Coast, Queensland, Australia.
Department of Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
Intern Med J. 2023 May;53(5):773-778. doi: 10.1111/imj.15747. Epub 2022 May 27.
Double-hit lymphoma (DHL) is an aggressive subtype of high-grade B-cell lymphoma with inferior prognosis using standard dose chemotherapy. Controversy remains whether more intensive chemotherapy regimens such as dose-adjusted etoposide, prednisolone, vincristine, cyclophosphamide, doxorubicin and rituximab (DA-EPOCH-R) provide better outcomes in this cohort.
To review consecutive cases of DHL treated with DA-EPOCH-R at our institution in comparison to available literature.
We conducted a retrospective study of 13 consecutive patients with DHL treated with DA-EPOCH-R at our institution. Primary endpoints included complete response (CR), event-free survival (EFS) and overall survival (OS).
CR rate with DA-EPOCH-R in DHL was 69% in our cohort. Median EFS and OS duration was 61 months (95% CI: 41-86 months) and 64 months (95% CI: 42-86 months) respectively. One patient discontinued DA-EPOCH-R due to recurrent febrile neutropenia and there were no treatment or infection-related deaths during the study.
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. Further prospective studies are warranted to confirm these findings.
双打击淋巴瘤（DHL）是一种侵袭性高级别 B 细胞淋巴瘤亚型，采用标准剂量化疗预后较差。是否更强化疗方案，如剂量调整依托泊苷、泼尼松、长春新碱、环磷酰胺、多柔比星和利妥昔单抗（DA-EPOCH-R），能为这一患者群体带来更好的结果，目前仍存在争议。
本研究回顾性分析了我院采用 DA-EPOCH-R 治疗的连续 DHL 病例，并与现有文献进行了比较。
我们对我院采用 DA-EPOCH-R 治疗的 13 例连续 DHL 患者进行了回顾性研究。主要终点包括完全缓解（CR）、无事件生存（EFS）和总生存（OS）。
本研究中，DHL 患者采用 DA-EPOCH-R 治疗的 CR 率为 69%。中位 EFS 和 OS 持续时间分别为 61 个月（95%CI：41-86 个月）和 64 个月（95%CI：42-86 个月）。1 例患者因反复发热性中性粒细胞减少而停止接受 DA-EPOCH-R 治疗，在研究期间无治疗相关或感染相关死亡。
本研究表明，DA-EPOCH-R 是一种耐受良好的门诊治疗方案，适用于身体状况适宜的患者的初始治疗。需要进一步的前瞻性研究来证实这些发现。
