A comparison of R-EPOCH and R-CHOP as a first-line regimen inde novoDLBCL patients with high Ki-67 expression in a single institution

// Jia-Jia Huang 1, 2 , Yi Xia 1, 2 , Yu Wang 1, 2 , Pan-Pan Liu 1, 2 , Xi-Wen Bi 1, 2 , Peng Sun 1, 2 , Tong-Yu Lin 1, 2 , Wen-Qi Jiang 1, 2 , Zhi-Ming Li 1, 2 1 State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China 2 Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China Correspondence to: Zhi-Ming Li, email: lzmsysu@hotmail.com Keywords: R-EPOCH, DLBCL, Ki-67 expression, R-CHOP Received: December 11, 2015      Accepted: March 31, 2016      Published: May 10, 2016 ABSTRACT Diffuse large B-cell lymphoma (DLBCL) patients with high Ki-67 expression receive limited benefits from R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) therapy. This study aims to compare the R-EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin) and R-CHOP regimens as first-line therapy in DLBCL patients with high Ki-67 expression. Data from 44 untreated DLBCL patients with high Ki-67 expression receiving R-EPOCH therapy were matched with those from 132 untreated DLBCL patients with high Ki-67 expression receiving R-CHOP therapy based on the International Prognostic Index (IPI: age, Ann Arbor stage, performance status, LDH level, number of extranodal sites), gender, and Ki-67 expression. In the R-EPOCH group, 42/44 patients were eligible for response evaluation. A total of 35 patients (83.3%) achieved complete remission (CR); 6 patients (14.3%) achieved partial remission (PR); and one patient (2.4%) exhibited progressive disease (PD) after 2 cycles of therapy. Patients in the R-EPOCH group presented better survival outcomes than those in the R-CHOP group (3-year overall survival [OS]: 89.9% vs. 70.2%, p = 0.041; 3-year progression-free survival [PFS]: 86.6% vs. 59.7%, p = 0.024). The survival superiority of the R-EPOCH over the R-CHOP regimen persisted when considering only patients of low-to-intermediate IPI risk, but it was not observed in those of high IPI risk. Our data suggest that R-EPOCH could be superior to R-CHOP as a first-line regimen in DLBCL patients with high Ki-67 expression, especially in those of low-to-intermediate IPI risk.