Optimally Delivered R-da-EPOCH Versus R-CHOP-21 in Primary Mediastinal Large B-Cell Lymphoma: A Real-Life Comparison in a Single Academic Center
Simple Summary
Abstract
1. Introduction
2. Patients and Methods
3. Results
3.1. Patient Characteristics and Delivery of Chemotherapy
3.2. Outcomes
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Patient Characteristics | R-da-EPOCH % n = 35 | R-CHOP % n = 35 | p-Value | ||
---|---|---|---|---|---|
# | % | # | % | ||
Age (Median, Range) | 35 (16–51) | 28 (16–59) | 0.01 | ||
Age ≥ 38 years old | 15/35 | 43 | 3/35 | 9 | 0.001 |
Females | 26/35 | 74 | 22/35 | 63 | 0.30 |
Β-symptoms | 7/35 | 20 | 7/33 | 21 | 0.90 |
PS ≥ 2 | 7/35 | 20 | 8/34 | 24 | 0.72 |
Stage ΙΙΙ/IV | 10/35 | 29 | 6/33 | 18 | 0.31 |
Any extranodal site | 13/35 | 37 | 17/35 | 49 | 0.33 |
Extranodal sites ≥ 2 | 4/35 | 11 | 9/35 | 26 | 0.12 |
Extrathoracic disease | 8/35 | 23 | 4/35 | 11 | 0.21 |
Kidney/Adrenal involvement | 3/35 | 9 | 2/35 | 6 | 0.64 |
Serous effusions | 13/35 | 37 | 21/33 | 64 | 0.03 |
Bulky disease ≥ 10 cm | 25/35 | 71 | 21/32 | 66 | 0.61 |
Serum LDH elevated | 29/35 | 83 | 30/34 | 88 | 0.53 |
Serum LDH ≥ 2x | 15/35 | 43 | 11/34 | 32 | 0.37 |
IPI ≥ 2 | 13/35 | 37 | 16/35 | 46 | 0.47 |
aaIPI ≥ 2 | 13/35 | 37 | 12/35 | 34 | 0.80 |
Model A: E/IV and LDH ≥ 2xUNL * | 0.89 | ||||
No adverse factors | 15/35 | 43 | 15/34 | 44 | |
1 adverse factor | 12/35 | 34 | 10/34 | 29 | |
2 adverse factors | 8/35 | 23 | 9/34 | 27 | |
Model B: E/IV and bulk | 0.91 | ||||
No adverse factors | 8/35 | 23 | 6/32 | 19 | |
1 adverse factor | 16/35 | 46 | 15/32 | 47 | |
2 adverse factors | 11/35 | 31 | 11/32 | 34 |
Maximum R-da-EPOCH Level | All Patients (n = 35) | Strictly Delivered EPOCH Subgroup (n = 33) | ||
---|---|---|---|---|
# | % | # | % | |
1 | 2 | 5.7 | 2 | 6.1 |
2 | 2 | 5.7 | 2 | 6.1 |
3 | 14 | 40.0 | 14 | 42.4 |
4 | 9 | 25.7 | 8 | 24.2 |
5 | 6 | 17.1 | 5 | 15.2 |
6 | 2 | 5.7 | 2 | 6.1 |
Maximum R-da-EPOCH level | All patients (n = 35) | NCI Study [22] (n = 51) | ||
# | % | # | % | |
1 | 2 | 5.7 | 6 | |
≥3 | 31 | 88.5 | ||
≥4 | 17 | 48.5 | “>50%” |
Freedom from Progression | Event-Free Survival | Overall Survival | |||||||
---|---|---|---|---|---|---|---|---|---|
Hazard Ratio | 95% CI | p-Value | Hazard Ratio | 95% CI | p-Value | Hazard Ratio | 95% CI | p-Value | |
Multivariate Model including Treatment Regimen, Age and Presence of any Serositis | |||||||||
R-da-EPOCH vs. R-CHOP-21 | 0.24 | 0.07–0.88 | 0.031 | 0.41 | 0.14–1.20 | 0.103 | 0.16 | 0.02–1.32 | 0.089 |
Age ≥ 38 years old | NS | NS | NS | ||||||
Any serositis | NS | NS | NS | ||||||
Multivariate Model including Treatment Regimen and Prognostic Model A (E/IV and/or LDH ≥ 2x) | |||||||||
R-da-EPOCH vs. R-CHOP-21 | 0.21 | 0.06–0.76 | 0.017 | 0.37 | 0.12–1.08 | 0.068 | 0.17 | 0.02–1.36 | 0.095 |
E/IV and/or LDH ≥ 2xUNL * | 0.072 | 0.069 | NS | ||||||
1 factor vs. 0 factors | 4.96 | 1.26–19.57 | 0.022 | 4.75 | 1.20–18.73 | 0.026 | |||
2 factors vs. 0 factors | 2.66 | 0.60–11.89 | 0.20 | 4.01 | 1.002–16.03 | 0.050 | |||
Multivariate Model including Treatment Regimen and Prognostic Model A (E/IV and/or bulk) | |||||||||
R-da-EPOCH vs. R-CHOP-21 | 0.26 | 0.07–0.97 | 0.044 | 0.45 | 0.15–1.33 | 0.147 (NS) | 0.18 | 0.02–1.54 | 0.12 (NS) |
E/IV and/or bulk | NS | NS | NS | ||||||
1 factor vs. 0 factors | |||||||||
2 factors vs. 0 factors |
Patients (#) | Progression Free Survival (PFS) | Overall Survival (OS) | |||
---|---|---|---|---|---|
Author [REF] | Type of Study | R-da-EPOCH Group | Comparator Group | R-da-EPOCH vs. Comparator | R-da-EPOCH vs. Comparator |
Shah et al. [41] | Propensity-weighted retrospective analysis | 76 | 56 * | HR: 0.62; 95% CI: 0.24–1.47 p = 0.28 | HR: 0.63; 95% CI 0.19–2.15 p = 0.46 |
Chan et al. [47] | Retrospective study | 46 | 78 ** | 88.5% vs. (90% vs. 56%) ** at 5 years p = 0.002 | NR |
Malenda et al. [48] | Retrospective study | 28 | 25 * | 87% vs. 74% at 1 year p = 0.21 | 100% vs. 92% at 1 year p = 0.81 |
Morgenstern et al. [42] | Retrospective study | 31 | 25 *** | 26% vs. 16% relapse at 2 years p = 0.37 | NR |
Stepanishyna et al. [49] | Prospective rando-mized clinical trial | 44 | 40 * | 90.9% vs. 64.1% at 5 years p = 0.002 | 97.7% vs. 73.8% at 5 years p = 0.002 |
Rehman et al. [56] | Systematic review | 256 | 213 ¶ | RR: 0.76; 95% CI: 0.57–1.02 p = 0.06 | RR:0.84; 95% CI 0.72–0.97 p = 0.02 ¶¶ |
Piperidou et al. present study | Retrospective study | 35 | 35 * | 91% vs. 69% at 5 years p = 0.027 | 97% vs. 80% at 5 years p = 0.063 |
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Piperidou, A.; Angelopoulou, M.K.; Chatzidimitriou, C.; Asimakopoulos, J.V.; Arapaki, M.; Panitsas, F.; Tsourouflis, G.; Belia, M.; Konstantinou, I.; Kopsaftopoulou, A.; et al. Optimally Delivered R-da-EPOCH Versus R-CHOP-21 in Primary Mediastinal Large B-Cell Lymphoma: A Real-Life Comparison in a Single Academic Center. Cancers 2025, 17, 1699. https://doi.org/10.3390/cancers17101699
Piperidou A, Angelopoulou MK, Chatzidimitriou C, Asimakopoulos JV, Arapaki M, Panitsas F, Tsourouflis G, Belia M, Konstantinou I, Kopsaftopoulou A, et al. Optimally Delivered R-da-EPOCH Versus R-CHOP-21 in Primary Mediastinal Large B-Cell Lymphoma: A Real-Life Comparison in a Single Academic Center. Cancers. 2025; 17(10):1699. https://doi.org/10.3390/cancers17101699
Chicago/Turabian StylePiperidou, Alexia, Maria K. Angelopoulou, Chrysovalantou Chatzidimitriou, John V. Asimakopoulos, Maria Arapaki, Fotios Panitsas, Gerassimos Tsourouflis, Marina Belia, Iliana Konstantinou, Anastasia Kopsaftopoulou, and et al. 2025. "Optimally Delivered R-da-EPOCH Versus R-CHOP-21 in Primary Mediastinal Large B-Cell Lymphoma: A Real-Life Comparison in a Single Academic Center" Cancers 17, no. 10: 1699. https://doi.org/10.3390/cancers17101699
APA StylePiperidou, A., Angelopoulou, M. K., Chatzidimitriou, C., Asimakopoulos, J. V., Arapaki, M., Panitsas, F., Tsourouflis, G., Belia, M., Konstantinou, I., Kopsaftopoulou, A., Liaskas, A., Machairas, A., Lefaki, M.-A., Dimitrakoudi, M., Sachanas, S., Pangalis, G. A., Konstantopoulos, K., Plata, E., Siakantaris, M., & Vassilakopoulos, T. P. (2025). Optimally Delivered R-da-EPOCH Versus R-CHOP-21 in Primary Mediastinal Large B-Cell Lymphoma: A Real-Life Comparison in a Single Academic Center. Cancers, 17(10), 1699. https://doi.org/10.3390/cancers17101699