Retrospective evaluation of R-EPOCH in the frontline treatment of adult patients with PTLD after solid organ transplant
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) ha...
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Elsevier
2025-05-01
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| Series: | Blood Neoplasia |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2950328025000299 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Brian Cuzzo |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-fdccedf223e64d25a81c3c4f9fea35a9 |
| institution | OA Journals |
| issn | 2950-3280 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Blood Neoplasia |
| spelling | doaj-art-fdccedf223e64d25a81c3c4f9fea35a92025-08-20T01:51:13ZengElsevierBlood Neoplasia2950-32802025-05-012210009410.1016/j.bneo.2025.100094Retrospective evaluation of R-EPOCH in the frontline treatment of adult patients with PTLD after solid organ transplantBrian Cuzzo0Maegan Ford1Saagar Jain2Hua-Jay Cherng3Evelyn Orlando4Patrick Gould5Amy Song6Benjamin May7Yuxuan Chen8Govind Bhagat9Andrew H. Lipsky10Barbara Pro11Jennifer E. Amengual12Division of Hematology and Oncology, Columbia University Irving Medical Center, New York, NYPediatric Hematology-Oncology, Children’s Hospital of New Jersey at Beth Israel Medical Center, Newark, NJColumbia University Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NYDivision of Hematology and Oncology, Columbia University Irving Medical Center, New York, NYDivision of Hematology and Oncology, Weill Cornell Medical Center, New York, NYDepartment of Medicine, Columbia University Irving Medical Center, New York, NYDepartment of Medicine, Columbia University Irving Medical Center, New York, NYDivision of Hematology and Oncology, Columbia University Irving Medical Center, New York, NYDivision of Hematology and Oncology, Columbia University Irving Medical Center, New York, NYDepartment of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NYDivision of Hematology and Oncology, Columbia University Irving Medical Center, New York, NYDivision of Hematology and Oncology, Columbia University Irving Medical Center, New York, NYDivision of Hematology and Oncology, Columbia University Irving Medical Center, New York, NY; Correspondence: Jennifer E. Amengual, Division of Hematology and Oncology, Columbia University Medical Center, William Black Building Room 901, 650 W 168th St, New York, NY 10032;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.http://www.sciencedirect.com/science/article/pii/S2950328025000299 |
| spellingShingle | 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 Retrospective evaluation of R-EPOCH in the frontline treatment of adult patients with PTLD after solid organ transplant Blood Neoplasia |
| title | Retrospective evaluation of R-EPOCH in the frontline treatment of adult patients with PTLD after solid organ transplant |
| title_full | Retrospective evaluation of R-EPOCH in the frontline treatment of adult patients with PTLD after solid organ transplant |
| title_fullStr | Retrospective evaluation of R-EPOCH in the frontline treatment of adult patients with PTLD after solid organ transplant |
| title_full_unstemmed | Retrospective evaluation of R-EPOCH in the frontline treatment of adult patients with PTLD after solid organ transplant |
| title_short | Retrospective evaluation of R-EPOCH in the frontline treatment of adult patients with PTLD after solid organ transplant |
| title_sort | retrospective evaluation of r epoch in the frontline treatment of adult patients with ptld after solid organ transplant |
| url | http://www.sciencedirect.com/science/article/pii/S2950328025000299 |
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