271P - Comparison between CHOP like regimens and DAEPOCH with or without Rituximab in adult high grade B cell lymphoma NOS; A retrospective study from a tertiary cancer hospital in South India

Background

High grade B cell lymphomas (HGBCL) are aggressive lymphomas, grouped into two entities according to whether or not they express double hit/double expresser phenotype. Entity without double hit/expresser phenotype is termed as HGBCL NOS. Best therapeutic approach to patients with HGBCL NOS is not known; treated with either regimens ideal for DLBCL or with more intensive Burkitt’s like regimens.

Methods

Hospital records of patients diagnosed with HGBCL NOS were retrieved. 34 patients had been non randomly assigned to receive CHOP like regimens (CHOP [20], COP [2], CHOP+HD MTX [5]) or dose adjusted (DA) EPOCH [7] with or without Rituximab[13]. Response rate (RR) to chemoimmunotherapy, toxicity profiles, PFS at 20 months of follow up and OS were noted.

Results

76.4 %(26) were diagnosed with advanced stage. 76.4%(26) had extra-nodal involvement. overall RR to first line therapy was 100%( CR = 58.8%, PR = 29.4%, SD = 11.8%). 48.1% CR and 37.0% PR in the CHOP like regimen arm and 100% CR rate in patients receiving DAEPOCH. At 20 months follow up, the mean and median PFS was 14.8 months and 11 months. DAEPOCH was associated with highest mean and median PFS (23.7 and 30 months) and same for CHOP were (10.31 and 9 months) at 20months of follow up(p = 0.039). Median OS not reached at 20 months of follow up. Use of Rituximab was associated with improved median PFS (30m vs 10m; p = 0.038) at 20 months, in univariate analysis. On an average 1.54 episodes of grade 3-4 neutropenia and 0.65 episodes of febrile neutropenia occurred per patient. Corresponding values for DAEPOCH and CHOP like regimens were (3.7 , 1.5) and ( 0.92, 0.40). 2(5.88%)cases had treatment related death, one each in DAEPOCH(14.2%) and CHOP like regimen arm (3.7%) arm. 21(61.76%) patients relapsed at one year.

Conclusions

Regimens like CHOP or DAEPOCH with Rituximab has high response rates but substantial proportion of patients may relapse. Grade 3-4 neutropenia occurs more frequently with DAEPOCH than CHOP, but treatment related mortality is low for both the regimens. Good PS patients do tolerate intensive regimens. Intensive regimens may be associated with longer PFS that may lead to longer OS.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.