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Since prognosis of patients with relapsed or refractory NHL is very poor, an effective salvage regimen is required to be investigated. We retrospectively evaluated the efficacy and safety of dose-adjusted EPOCH (DA-EPOCH) reported by Wilson et al. for relapsed or refractory NHL in our institute.

Patients and methods

Patients with relapsed or refractory NHL selected based on practical clinical situation were treated with DA-EPOCH. The starting dose was as follows: doxorubicin 10 mg/m2, etoposide 50 mg/m2 and vincristine 0.4 mg/m2 as a continuous infusion on days 1–4, cyclophosphamide 750 mg/m2 intravenously on day 5 and oral prednisone 60 mg/m2 twice a day on days 1–5. G-CSF was started on day 6 until neutrophil recovered to more than 5000/μl. The dose was adjusted according to hematologic toxic effects. Patients with CD20-positive B-cell NHL (B-NHL) received DA-EPOCH with rituximab (DA-EPOCH-R). Response was evaluated in patients who received three cycles or more, and toxicity was evaluated in all patients.


A total of 22 patients (male/female = 13/9) were treated with DA-EPOCH (11 patients with T-cell NHL) or DA-EPOCH-R (11 patients with B-NHL). Median age was 61 years (range 44–81), and median number of prior therapy was 2 (range 1–4). The median dose level of DA-EPOCH was 100% (range 80–100%). The treatment was discontinued in nine patients, due to disease progression in four patients and prolonged toxic effects in five patients. Seven patients achieved CR and two patients achieved PR (40.9% of ORR). The most frequent toxicity was transient grade 4 neutropenia observed in 20 patients (91.0%). Grade 3 febrile neutropenia was observed in seven patients (31.8%). Dose reduction was required in 6 of 13 patients who received at least three cycles. No treatment-related death was observed.


DA-EPOCH(-R) regimen is effective and well tolerated, even in heavily pretreated patients with relapsed or refractory NHL. Further prospective large scaled study is warranted in Japan.

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