Table 2.
R-CHOP vs DA-R-EPOCH for Various Subtypes of DLBCL
| DLBCL Subtype | Recommended Regimens (in Preferred Order) | Evidence |
|---|---|---|
| Clinical and Biological Scenarios in Which DA-R-EPOCH Is Preferred | ||
| High-grade B-cell lymphoma with DHL/THL | DA-R-EPOCH (only phase 2 data) or R-CHOP | Phase 2 data demonstrating high 5-y OS rates with DA-R-EPOCH vs historical rates with R-CHOP. |
| PMBL | DA-R-EPOCH (only phase 2 data) or R-CHOP + consolidative radiation | Phase 2 data demonstrating higher 5-y OS rates with DA-R-EPOCH vs historical rates with R-CHOP, and toxicities from consolidative radiation may potentially be avoided. |
| HIV-associated DLBCL | DA-R-EPOCH (only phase 2 data) or R-CHOP | Phase 2 data demonstrating higher 2-y OS rates with DA-R-EPOCH vs historical rates with R-CHOP. |
| GZL | DA-R-EPOCH (only phase 2 data) or R-CHOP | Phase 2 data demonstrating higher 3-y OS rates vs historical rates with R-CHOP. |
| Clinical and Biological Scenarios in Which DA-R-EPOCH vs R-CHOP Is Controversial | ||
| High-risk IPI scores (IPI 3–5) | R-CHOP | Phase 3 intergroup trial showed no difference in OS on the basis of IPI risk group. |
| GCB type | R-CHOP | R-CHOP is the therapeutic standard for GCB DLBCL, which is the best prognostic subtype. |
| ABC type | R-CHOP | No high-quality data are available comparing R-CHOP vs DA-R-EPOCH. |
| DEL | R-CHOP | Phase 3 intergroup trial showed no difference in OS on the basis of DEL phenotype, although the study was likely underpowered for this post hoc analysis. |
| Richter syndrome | R-CHOP | Clinical trials are paramount for this very poor prognostic subtype. DA-R-EPOCH has significant rates of toxicity. |
| Testicular DLBCL | R-CHOP | No data are available comparing R-CHOP vs DA-R-EPOCH. |
ABC, activated B-cell; DA-R-EPOCH, dose-adjusted rituximab, etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin; DEL, double-expressor lymphoma; DHL, double-hit lymphoma; DLBCL, diffuse large B-cell lymphoma; GCB, germinal center B-cell; GZL, gray zone lymphoma; IPI, International Prognostic Index; OS, overall survival; PMBL, primary mediastinal B-cell lymphoma; R-CHOP, rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone; THL, triple-hit lymphoma; y, year(s).