Retrospective evaluation of R-EPOCH in the frontline treatment of adult patients with PTLD after solid organ transplant

Blood Neoplasia Pub Date : 2025-05-01 DOI:10.1016/j.bneo.2025.100094

Brian Cuzzo , Maegan Ford , Saagar Jain , Hua-Jay Cherng , Evelyn Orlando , Patrick Gould , Amy Song , Benjamin May , Yuxuan Chen , Govind Bhagat , Andrew H. Lipsky , Barbara Pro , Jennifer E. Amengual

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Abstract

Posttransplant lymphoproliferative disorders (PTLD) are rare complications of solid organ transplantation, which carry significant morbidity and mortality. Phase 2 trials that use sequential rituximab (R) followed by R, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) have become an acceptable approach for B-cell PTLD, although it carries a high risk of treatment-related mortality (up to 11%). Many aspects of B-cell PTLD biology and patient characteristics parallel AIDS-related lymphomas in which dose-modified R, etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (DM-R-EPOCH) has been demonstrated to be highly efficacious and safe. In this single-institution retrospective study of (N = 101) adult transplant recipients with B-cell PTLD, 65 received DM-R-EPOCH, 8 received R-CHOP, and 17 received R monotherapy. Median progression-free and overall survival was 4.4 years and 6.4 years, respectively, for DM-R-EPOCH and 1 year and 1.1 years, respectively, for R-CHOP. Rates of neutropenia and infection were 70% and 77%, respectively, for DM-R-EPOCH, and 88% each for R-CHOP. Treatment-related mortality for patients treated with DM-R-EPOCH and R-CHOP was 4.7% and 25%, respectively. The median number of cycles of DM-R-EPOCH was 6, and between 73% and 89% of patients received a relative dose intensity of ≥80% for cyclophosphamide, etoposide, and doxorubicin. The relative dose intensity of vincristine was <80% in 56% of patients because of frequent omission for gastrointestinal involvement of PTLD. Collectively, these data suggest that DM-R-EPOCH does not lead to excessive toxicity in patients with B-cell PTLD and support the need for further prospective clinical studies.

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R-EPOCH在成人实体器官移植后PTLD一线治疗中的回顾性评价

摘要移植后淋巴细胞增生性疾病（PTLD）是实体器官移植的罕见并发症，其发病率和死亡率都很高。2期临床试验使用顺序利妥昔单抗(R)，随后使用R、环磷酰胺、阿霉素、长春新碱和泼尼松（R- chop）治疗b细胞PTLD已成为一种可接受的方法，尽管它具有较高的治疗相关死亡率风险（高达11%）。b细胞PTLD生物学和患者特征的许多方面与艾滋病相关淋巴瘤相似，其中剂量修饰R、乙泊苷、强的松、长春新碱、环磷酰胺和阿霉素（DM-R-EPOCH）已被证明是高效和安全的。在这项对101例b细胞PTLD成人移植受者的单机构回顾性研究中，65例接受DM-R-EPOCH治疗，8例接受R- chop治疗，17例接受R单药治疗。DM-R-EPOCH的中位无进展生存期和总生存期分别为4.4年和6.4年，R-CHOP的中位无进展生存期和总生存期分别为1年和1.1年。DM-R-EPOCH的中性粒细胞减少率为70%，感染率为77%，R-CHOP的中性粒细胞减少率为88%。DM-R-EPOCH和R-CHOP治疗患者的治疗相关死亡率分别为4.7%和25%。DM-R-EPOCH的中位周期数为6个，73%至89%的患者接受了环磷酰胺、依托泊苷和阿霉素的相对剂量强度≥80%。在56%的患者中，由于经常遗漏PTLD累及胃肠道，长春新碱的相对剂量强度为80%。总的来说，这些数据表明DM-R-EPOCH不会导致b细胞PTLD患者过度毒性，并支持进一步前瞻性临床研究的必要性。

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Blood Neoplasia

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