Pegylated GCSF Can Be Used With First-Line da-EPOCH-R Without Compromising Dose Intensity, Safety, or Efficacy

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Dose-adjusted EPOCH-R (etoposide, doxorubicin, and cyclophosphamide with vincristine, prednisone, and rituximab) remains a therapeutic option for high-risk, aggressive B-cell non-Hodgkin lymphoma subsets. Whether pegylated granulocyte colony-stimulating factor (peg-GCSF) affords similar efficacy compared with daily granulocyte colony-stimulating factor is unknown. In this study we found similar attained dose level and patient outcomes, supporting a role for peg-GCSF with dose-adjusted EPOCH-R.


Infusional da-EPOCH-R (dose-adjusted etoposide, doxorubicin, and cyclophosphamide with vincristine, prednisone, and rituximab) is a dose-intensified regimen with a potential role in treating high-risk subtypes of aggressive B-cell non-Hodgkin lymphoma (B-NHL). Studies of da-EPOCH-R use daily injections of granulocyte colony-stimulating factor (GCSF) to tailor chemotherapy dosing, and whether 1-time administration of pegylated GCSF (peg-GCSF) is as efficacious has not been addressed.

Patients and Methods:

We reviewed aggressive B-NHL patients treated at our center with first-line da-EPOCH-R for clinician choice of growth factor, and analyzed dose level achieved, rate of unplanned hospitalizations, and patient outcomes.


Among 73 patients, 44 received peg-GCSF. Overall, 11 patients (15%) patients achieved dose level 4. Baseline characteristics between peg-GCSF and GCSF groups were similar. The proportion of patients who achieved dose level 4 was comparable in the peg-GCSF group (5 of 44 [11%]) and daily GCSF (6 of 29 [21%]; P = .24). The rate of unplanned hospitalizations, and event-free and overall survival, were also similar between groups.


We suggest routine use of peg-GCSF is an acceptable alternative to daily GCSF, for patients in whom da-EPOCH-R is selected as first-line treatment for aggressive B-NHL.

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