Canterbury DHB


Modifications to R-CHOP21

In Germany, national trials found that adding etoposide (100 mg/m2 on day 1-3) to CHOP (CHEOP) improved results in young patients and in patients with T cell NHL. See Schmitz, N., et al. (2010). "Treatment and prognosis of mature T-cell and NK-cell lymphoma: and analysis of patients with T-cell lymphoma treated in studies of the German High-Grade Non-Hodgkin Lymphoma Study Group." Blood 116(18): 3418-3425.

Maxi-CHOP alternating with high dose cytarabine, as pioneered by the Nordic Group, has been used for patients with mantle cell lymphoma. Compared with CHOP, the dose of cyclophosphamide and doxyrubicin are increased to 1500 mg/m2 and 75 mg/m2 respectively. Alternate cycles are with 4 doses of cytosine arabinoside, 2 or 3 g/m2 over 2 days. Chemotherapy sheets are available.

Dose-adjusted Rituximab, Etoposide, Prednisone, Vincristine, Cyclophosphamide and Doxyrubicin (DA-REPOCH) has proved a well-tolerated and effective treatment for some of the more difficult aggressive lymphomas, particularly Double Hit DLBCL, Primary mediastinal B cell lymphoma, and even Burkitt lymphoma. DA-REPOCH may be given as an outpatient. Doses of etoposide cyclophosphamide and doxyrubicin are adjusted up or down depending on haematological toxicity. See Roschewski M, Dunleavy K, Abramson JS, et al. Multicenter Study of Risk-Adapted Therapy With Dose-Adjusted EPOCH-R in Adults With Untreated Burkitt Lymphoma. J Clin Oncol 2020:JCO2000303. DOI: 10.1200/JCO.20.00303.

A recent report in abstract is less optimistic about any improvement of DA-REPOCH over RCHOP for double hit lymphoma. See Magnusson T, Narkhede M, Mehta A, Goyal G. No difference in overall survival between R-CHOP and R-EPOCH among patients with advanced stage MYC-rearranged, double hit, or triple hit diffuse large B-Cell lymphoma. EHA abstracts 2021:S224.

Rituximab bendamustine and cytosine arabinoside has provided effective induction therapy for older patients with Mantle Cell Lymphoma who may not be able to tolerate the Nordic Protocol. See Visco, C., et al. (2017). "Rituximab, bendamustine, and low-dose cytarabine as induction therapy in elderly patients with mantle cell lymphoma: a multicentre, phase 2 trial from Fondazione Italiana Linfomi." Lancet Haematol 4(1): e15-e23.

About this Canterbury DHB document (6732):

Document Owner:

Peter Ganly (see Who's Who)

Last Reviewed:

December 2021

Next Review:

December 2024


Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 6732