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R-CHOEP14 in younger high-risk patients with large B cell lymphoma: an effective front-line regimen with cardiac toxicity: a real-life, single-center experience

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Abstract

Currently, there is no consensus regarding optimal front-line treatment for younger high-risk patients with large B cell lymphoma. American recommendations list only R-CHOP as standard, while European also include R-ACVBP and R-CHOEP14. We have been routinely using the latter regimen at our institution since 2011 and performed this retrospective real-life single-center study to analyze outcomes. Between September 2011 and April 2019, 66 newly diagnosed patients aged 18 to 60 years with B-large cell lymphoma and high-risk age-adjusted International Prognostic Index score were scheduled to receive 6 or 8 cycles of bi-weekly chemoimmunotherapy with cyclophosphamide, doxorubicin, vincristine, etoposide, steroids, and rituximab (R-CHOEP14). After a median follow-up of 4.7 years, the estimated 3-year progression-free survival was 87% (95% CI 80–96%) and 3-year overall survival 90% (95% CI 83–98%). Grade ≥ 3 hematological side effects occurred in 83% and infectious in 41% of patients; one patient died of toxicity. Grade ≥ 2 cardiac toxicity occurred in 21% of patients, more frequently than previously reported. The cumulative 5-year risk of congestive heart failure with all-cause mortality as the competing risk was 17%. R-CHOEP14 is a very effective and manageable regimen for younger high-risk patients with B-large cell lymphoma, but the risk of cardiotoxicity warrants further investigations.

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Funding

This study was funded by the University of Zagreb (grant numbers 1118002 and 1119002).

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Authors and Affiliations

  1. Division of Hematology, Department of Internal Medicine, University Hospital Centre Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia

    Sandra Bašić-Kinda, Ivo Radman, Dino Dujmović, Pavle Rončević, Marijo Vodanović, Ida Hude & Igor Aurer

  2. Department of Pathology and Cytology, University Hospital Centre Zagreb, Zagreb, Croatia

    Ivana Ilić

  3. Department of Radiology, University Hospital Centre Zagreb, Zagreb, Croatia

    Marko Kralik

  4. Medical School, University of Zagreb, Zagreb, Croatia

    Margareta Dobrenić, Zrinka Sertić & Igor Aurer

  5. Department of Nuclear Medicine, University Hospital Centre Zagreb, Zagreb, Croatia

    Margareta Dobrenić

  6. Department of Oncology, University Hospital Centre Zagreb, Zagreb, Croatia

    Lea Galunić-Bilić

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  1. Sandra Bašić-Kinda
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Correspondence to Igor Aurer.

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All procedures performed were in accordance with the ethical standards of the institutional ethical committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all patients included in this analysis.

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Bašić-Kinda, S., Radman, I., Dujmović, D. et al. R-CHOEP14 in younger high-risk patients with large B cell lymphoma: an effective front-line regimen with cardiac toxicity: a real-life, single-center experience. Ann Hematol 100, 1517–1524 (2021). https://doi.org/10.1007/s00277-020-04353-3

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