826P - Efficacy of non-doxorubicin based regimens in severely G6PD deficient patients with DLBCL

Background

G6PD deficiency is widely prevalent in the Middle East and the prevalence is 26% in Bahrain. There are reports linking G6PD deficiency to oxidative hemolysis with doxorubicin, while others describe use of doxorubicin without hemolysis. Many physicians treating severely G6PD deficient lymphoma patients substitute etoposide for doxorubicin in regimens such as CHOP. There is sparse data on the efficacy of such regimens.

Methods

We aimed to assess the efficacy of non-doxorubicin regimens in severely G6PD deficient diffuse large B cell lymphoma (DLBCL) patients. Secondary objectives were to evaluate hemolytic complications in deficient patients who had received doxorubicin. This study was approved by our institutional review board. In this retrospective study we included patients with DLBCL who received R-CHOP or R-CEOP regimens. Severe G6PD deficiency was defined as enzymatic activity < 10%. The primary end points were overall survival (OS) and event-free survival (EFS). Cox regression analysis was done to identify variables significantly associated with survival.

Results

Eighty-two patients were included of whom 15% were severely G6PD deficient. 90% of the cohort had received R-CHOP and the rest had received R-COEP. The baseline characteristics were balanced between the 2 groups. The median follow-up time was 2 years. Patients who received R-COEP had inferior 2-yr OS and EFS compared to the R-CHOP group. The 2-yr OS was 88.1% vs 50% (p-0.001) in the R-CHOP and R-COEP groups respectively and the corresponding 2-yr EFS was 77.5% and 33.3% (p-0.015). There was a trend to increased primary refractoriness with R-COEP (38% vs 18%, (p=0.1)). Seven patients (9.5%) with G6PD deficiency received doxorubicin, none had clinical or laboratory hemolysis. On multivariable analysis, high IPI score and receipt of R-COEP were associated with inferior OS, and EFS and with higher incidence of relapse.

Conclusions

G6PD deficiency is common among DLBCL patients in Bahrain. Use of R-COEP was associated with inferior survival compared to R-CHOP. Use of doxorubicin was not associated with hemolytic episodes. Larger studies are needed to confirm the safety of doxorubicin and are of particular relevance in middle-eastern countries where the prevalence of G6PD deficiency is high.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

S. Prem Sudha.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.